title: Comparison of hospital mortality during ST-segment elevation myocardial infarction in the era of reperfusion therapy in women versus men and in older versus younger patients.
abstract: There is intense interest in examining hospital mortality in relation to gender in ST-segment elevation myocardial infarction. The aim of the present study was to determine whether gender influences outcomes in men and women treated with the same patency-oriented reperfusion strategy. The influence of gender on hospital mortality was tested using multivariate analysis and local regression. The influence of age was tested as a continuous and as a categorical variable. In the overall population of 2,600 consecutive patients, gender was not correlated with hospital mortality except in the subgroup of women aged ≥65 years. The risk for death increased linearly in logit scale for men. Up to the age of 65 years, the risk also increased linearly in women but thereafter increased faster than in men. Testing age as a categorical variable, hospital mortality was higher in women than in men aged ≥75 years but was similar between the genders in the younger age categories. In conclusion, despite following an equal patency-oriented management strategy in men and women with ST-segment elevation myocardial infarctions, the risk for hospital death increased linearly with age but with an interaction between age and gender such that older women had an independent increase in hospital mortality. Longer time to presentation and worse baseline characteristics probably contributed to determine a high-risk subset but reinforce the need to apply, as recommended in the international guidelines in the management of patients with ST-segment elevation myocardial infarctions, the same strategy of acute reperfusion in men and women.
authors.affiliation: AP-HP, Cardiology Department, Hôpital Bichat, Université Paris Diderot, Sorbonne Paris-Cité, INSERM U-698, Paris, France. jean-michel.juliard@bch.aphp.fr
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Juliard
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Golmard
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.forename: Laurent J
authors.initials: LJ
authors.lastname: Feldman
authors.forename: Laurent
authors.initials: L
authors.lastname: Delorme
authors.forename: Gregory
authors.initials: G
authors.lastname: Ducrocq
authors.forename: Fleur
authors.initials: F
authors.lastname: Descoutures
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sorbets
authors.forename: Eric
authors.initials: E
authors.lastname: Garbarz
authors.forename: Olivier
authors.initials: O
authors.lastname: Boudvillain
authors.forename: Pierre
authors.initials: P
authors.lastname: Aubry
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D004562:Electrocardiography; D005260:Female; D005602:France / Q000453:epidemiology; D006329:Heart Conduction System / Q000503:physiopathology*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution