title: Female gender: an independent factor in ST-elevation myocardial infarction.
abstract: BACKGROUND
  Cardiovascular disease is the leading cause of death in women. In ST-elevation myocardial infarction (STEMI) in particular, the question has been raised whether specific characteristics of women confer a worse prognosis.
  
  
  OBJECTIVE
  To evaluate the differences in STEMI patients between the genders in cardiovascular risk profile, clinical presentation, therapeutic approach and in-hospital and 6-month mortality rates.
  
  
  METHODS
  We analyzed 1578 patients admitted consecutively with STEMI during a 7-year period (from January 13, 2002 to December 31, 2008). The patients were divided into two groups according to gender, and compared in terms of baseline clinical and demographic characteristics, pre-hospital and in-hospital delay, clinical presentation on admission, reperfusion therapy, severity of coronary disease and in-hospital and 6-month mortality.
  
  
  RESULTS
  Of the 1578 patients, 26% were female. Women were older (by 8 years), and had a higher cardiovascular risk profile. On admission, their clinical presentation was more severe, with a higher frequency of anterior myocardial infarction and acute heart failure symptoms. Women had longer ischemic times and lower rates of reperfusion therapy. Mortality in women was significantly higher than in men, both in-hospital (17.5 vs. 5.3%) and at 6 months (23.5% vs. 8.2%). After adjustment in multivariate analysis, mortality in women remained higher.
  
  
  CONCLUSIONS
  The adverse demographic and clinical profile could partially explain the worse prognosis of STEMI in women. This, together with longer pre-hospital delays, led to underuse of reperfusion therapy. Even so, female gender by itself had a negative and independent influence on mortality in STEMI patients.
authors.affiliation: Serviço de Cardiologia, Hospital de Faro, EPE, Faro, Portugal. jotrigo@gmail.com
authors.forename: Joana
authors.initials: J
authors.lastname: Trigo
authors.forename: Jorge
authors.initials: J
authors.lastname: Mimoso
authors.forename: Paula
authors.initials: P
authors.lastname: Gago
authors.forename: Nuno
authors.initials: N
authors.lastname: Marques
authors.forename: Ricardo
authors.initials: R
authors.lastname: Faria
authors.forename: Walter
authors.initials: W
authors.lastname: Santos
authors.forename: Rui
authors.initials: R
authors.lastname: Candeias
authors.forename: Salomé
authors.initials: S
authors.lastname: Pereira
authors.forename: Vasco
authors.initials: V
authors.lastname: Marques
authors.forename: Victor
authors.initials: V
authors.lastname: Brandão
authors.forename: Ana
authors.initials: A
authors.lastname: Camacho
authors.forename: Ilídio
authors.initials: I
authors.lastname: de Jesus
authors.forename: Veloso
authors.initials: V
authors.lastname: Gomes
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors