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Hospital mortality in women and men with acute cardiac ischemia: a prospective multicenter study
B E Coronado1, J L Griffith, J R Beshansky
1Center for Cardiovascular Health Services Research, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Insights
Gender does not independently predict hospital mortality in acute cardiac ischemia patients. Higher mortality trends in women with acute myocardial infarction (AMI) are explained by age, diabetes, and severity, not gender itself.
Area of Science:
- Cardiology
- Clinical Research
- Gender Health
Background:
- Women exhibit higher mortality rates from acute myocardial infarction (AMI) than men.
- The reasons for this disparity and its applicability to all acute ischemia cases remain unclear.
Purpose of the Study:
- To investigate gender-based differences in hospital mortality among patients diagnosed with acute cardiac ischemia.
- To determine if gender is an independent predictor of mortality in this patient population.
Main Methods:
- Analysis of data from a prospective, multicenter study.
- Inclusion of patients presenting to the emergency department (ED) with symptoms suggestive of acute ischemia.
- Comparison of demographic, clinical characteristics, and mortality rates between genders.
Main Results:
- No significant difference in overall acute ischemia mortality between genders (4.0% women vs. 3.5% men).
- A trend towards higher acute myocardial infarction (AMI) mortality in women (10.3% vs. 7.4%).
- After adjusting for age, diabetes, heart failure, and blood pressure, gender was not a predictor of mortality.
Conclusions:
- Gender is not an independent predictor of hospital mortality in patients with acute cardiac ischemia.
- Observed higher mortality trends in women with AMI are attributable to factors like older age, increased prevalence of diabetes, and higher Killip class at presentation.
Objectives:
This study sought to determine gender differences in hospital mortality in patients with acute cardiac ischemia.
Background:
It is unclear why women experience higher mortality from acute myocardial infarction (AMI) than men and whether this applies to all patients with acute ischemia.
Methods:
We analyzed data from a prospective multicenter study involving patients presenting to the emergency department (ED) with symptoms suggestive of acute ischemia.
Results:
Of 10,783 patients, 5,221 (48.4%) were women. Mean age was 60.5 years for women and 56.9 for men (p < 0.001). Women had more hypertension (54.6% vs. 45.9%, p < 0.001) and diabetes (23.3% vs. 17.0%, p < 0.001) than men but fewer previous AMIs (21.1% vs. 28.9%, p < 0.001). Acute ischemia was confirmed in 1,090 women (20.8%) and 1,451 men (26.1%, p < 0.001), including AMI in 322 women (6.2%) and 572 men (10.3%, p < 0.001). Women with an AMI were in a higher Killip class than men: class I in 60.3% versus 72.2%, class II in 19.3% versus 16%, class III in 15.5% versus 8.7% and class IV in 5% versus 3.1%, respectively (p = 0.001). There was no significant difference in mortality from acute ischemia between genders (4.0% vs. 3.5%, p = 0.6), but there was a trend for higher AMI mortality in women (10.3% vs. 7.4%, p = 0.1). After controlling for age, diabetes, heart failure and presenting blood pressure, gender did not predict mortality from acute ischemia (odds ratio 0.9, 95% confidence interval 0.5 to 1.4, p = 0.5).
Conclusions:
Among patients presenting to the ED with acute cardiac ischemia, gender does not appear to be an independent predictor of hospital mortality. The trend for higher mortality in women from AMI can be explained by their older age, greater frequency of diabetes and higher Killip class on presentation.