title: Editor's Choice- Gender difference in prognostic impact of in-hospital bleeding after myocardial infarction - data from the SWEDEHEART registry.
abstract: BACKGROUND
  Bleeding complications increase mortality in myocardial infarction patients. Potential gender difference in bleeding regarding prevalence and prognostic impact is still controversial.
  
  
  OBJECTIVE
  Gender comparison regarding incidence and prognostic impact of bleeding in patients hospitalised with myocardial infarction during 2006-2008.
  
  
  METHODS
  Observational study from the SWEDEHEART register. Outcomes were in-hospital bleedings, in-hospital mortality and one-year mortality in hospital survivors.
  
  
  RESULTS
  A total number of 50,399 myocardial infarction patients were included, 36.6% women. In-hospital bleedings were more common in women (1.9% vs. 3.1%, p<0.001) even after multivariable adjustment (odds ratio (OR) 1.17, 95% confidence interval (CI) 1.01-1.37). The increased risk for women was found in ST-elevation myocardial infarction (OR 1.46, 95% CI 1.10-1.94) and in those who underwent percutaneous coronary intervention (OR 1.80, 95% CI 1.45-2.24). In contrast the risk was lower in medically treated women (OR 0.79, 95% CI 0.62-1.00). After adjustment, in-hospital bleeding was associated with higher risk of one-year mortality in men (OR 1.35, 95% CI 1.04-1.74), whereas this was not the case in women (OR 0.97, 95% CI 0.72-1.31).
  
  
  CONCLUSIONS
  Female gender is an independent risk factor of in-hospital bleeding after myocardial infarction. A higher bleeding risk in women appeared to be restricted to invasively treated patients and ST-elevation myocardial infarction patients. Even though women have higher short- and long-term mortality, there was no difference between the genders among bleeders. After multivariable adjustment the prognostic impact of bleeding complications was higher in men.
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Holm
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden.
authors.forename: Sofia
authors.initials: S
authors.lastname: Sederholm Lawesson
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden eva.swahn@regionostergotland.se.
authors.forename: Eva
authors.initials: E
authors.lastname: Swahn
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden.
authors.forename: Joakim
authors.initials: J
authors.lastname: Alfredsson
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000401:mortality*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D000072658:Non-ST Elevated Myocardial Infarction / Q000188:drug therapy / Q000401:mortality*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D000072657:ST Elevation Myocardial Infarction / Q000188:drug therapy / Q000401:mortality; D017678:Sex Distribution; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin
keywords: Myocardial infarction; bleeding; gender; prognosis