title: Influence of gender on the risk of death and adverse events in patients with acute myocardial infarction undergoing pharmacoinvasive strategy.
abstract: Pharmacoinvasive treatment is an acceptable alternative for patients with ST-segment elevation myocardial infarction (STEMI) in developing countries. The present study evaluated the influence of gender on the risks of death and major adverse cardiovascular events (MACE) in this population. Seven municipal emergency rooms and the Emergency Mobile Healthcare Service in São Paulo treated STEMI patients with tenecteplase. The patients were subsequently transferred to a tertiary teaching hospital for early (<24 h) coronary angiography. A total of 469 patients were evaluated [329 men (70.1%)]. Compared to men, women had more advanced age (60.2 ± 12.3 vs. 56.5 ± 11 years; p = 0.002); lower body mass index (BMI; 25.85 ± 5.07 vs. 27.04 ± 4.26 kg/m2; p = 0.009); higher rates of hypertension (70.7 vs. 59.3%, p = 0.02); higher incidence of hypothyroidism (20.0 vs. 5.5%; p < 0.001), chronic renal failure (10.0 vs. 8.8%; p = 0.68), peripheral vascular disease (PVD; 19.3 vs. 4.3%; p = 0.03), and previous history of stroke (6.4 vs. 1.3%; p = 0.13); and higher thrombolysis in myocardial infarction risk scores (40.0 vs. 23.7%; p < 0.001). The overall in-hospital mortality and MACE rates for women versus men were 9.3 versus 4.9% (p = 0.07) and 12.9 versus 7.9% (p = 0.09), respectively. By multivariate analysis, diabetes (OR 4.15; 95% CI 1.86-9.25; p = 0.001), previous stroke (OR 4.81; 95% CI 1.49-15.52; p = 0.009), and hypothyroidism (OR 3.75; 95% CI 1.44-9.81; p = 0.007), were independent predictors of mortality, whereas diabetes (OR 2.05; 95% CI 1.03-4.06; p = 0.04), PVD (OR 2.38; 95% CI 0.88-6.43; p = 0.08), were predictors of MACE. In STEMI patients undergoing pharmacoinvasive strategy, mortality and MACE rates were twice as high in women; however, this was due to a higher prevalence of risk factors and not gender itself.
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Lanaro
authors.forename: Adriano
authors.initials: A
authors.lastname: Caixeta
authors.forename: Juliana A
authors.initials: JA
authors.lastname: Soares
authors.forename: Cláudia Maria Rodrigues
authors.initials: CM
authors.lastname: Alves
authors.forename: Adriano Henrique Pereira
authors.initials: AH
authors.lastname: Barbosa
authors.forename: José Augusto Marcondes
authors.initials: JA
authors.lastname: Souza
authors.forename: José Marconi Almeida
authors.initials: JM
authors.lastname: Sousa
authors.forename: Amaury
authors.initials: A
authors.lastname: Amaral
authors.forename: Guilherme M
authors.initials: GM
authors.lastname: Ferreira
authors.forename: Antônio Célio
authors.initials: AC
authors.lastname: Moreno
authors.forename: Iran Gonçalves
authors.initials: IG
authors.lastname: Júnior
authors.forename: Edson
authors.initials: E
authors.lastname: Stefanini
authors.forename: Antônio Carlos
authors.initials: AC
authors.lastname: Carvalho
mesh_terms: D000368:Aged; D004632:Emergency Medical Services / Q000639:trends; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D000077785:Tenecteplase; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase