Gender differences in the diagnosis and treatment of acute myocardial infarction in Lebanon

To study the gender differences in presentation, diagnosis and treatment of acute myocardial infarction in Lebanon.

Consecutive admissions due to myocardial infarction to 18 medical centers in various regions of Lebanon were entered into the Lebanese Myocardial Infarction Study, conducted between January and July 1996. Information was obtained on age, gender, time of onset of symptoms, delay to hospital arrival, mode of transport, and coronary risk factor analysis. The patients were followed up in hospital for analysis of modes of therapy, complications and mortality.

Of 433 admissions, 99 were female. Compared to men, women were older, presented later, smoked less but tended to have a higher frequency of hypertension. The other coronary risk factors were similarly prevalent in males and females. Inotropic agents were used more commonly in females but thrombolytics were used less so. Women tended to develop more heart failure and had significantly higher incidence of recurrent ischemia or myocardial infarction, high level atrioventricular block and atrial arrhythmias. The overall mortality rate was higher in females than in males (16.2% vs. 8.1%, P = 0.037).

The results reveal similarities between gender differences among Lebanese and Western populations. The higher mortality rate in women may relate to the late arrival to hospital, the older age and the more frequent complications. This emphasizes the need to educate women about coronary risk and to urge them to seek early medical care.