Gender and In-hospital Mortality of ST-Segment Elevation Myocardial Infarction (from a Multihospital Nationwide Registry Study of 31,689 Patients)

doi:10.1016/j.amjcard.2014.11.001

The American Journal of Cardiology

Volume 115, Issue 3, 1 February 2015, Pages 303-306

https://doi.org/10.1016/j.amjcard.2014.11.001 Get rights and content

Previous studies have suggested that women may be at higher risk of death after ST-segment elevation myocardial infarction (STEMI). We studied potential associations of gender and age with in-hospital mortality using a registry of 31,689 consecutive patients with STEMI aged ≥30 years (66.3% men, mean age 67.8 years) treated in 22 hospitals. Total in-hospital mortality rate of STEMI was 11.2%. Women had higher unadjusted mortality rate compared with men (17.5% vs 8.0%; hazard ratio 1.65; 95% confidence interval [CI] 1.54 to 1.76, p <0.0001). However, when adjusted for age and co-morbidities, there was no difference in mortality between genders overall (hazard ratio 1.04; 95% CI 0.97 to 1.12, p = 0.2303) or at any age group. Mortality rate was highly dependent of age with an estimated increase of 86% (95% CI 80% to 92%) per 10-year increase in age (p <0.0001). Chronic coronary, peripheral, or cerebral artery disease, diabetes, renal insufficiency, malignancy, and severe infection were independent predictors of mortality in multivariate analysis. Atrial fibrillation was associated with survival in multivariate model. Anterior location of STEMI was not independently associated with in-hospital mortality. In conclusion, although women have higher total in-hospital mortality rate than men after STEMI, this difference does not appear to be caused by gender itself but to be due to of differences in age and co-morbidities.

Section snippets

Methods

Study population included 31,689 consecutive patients aged ≥30 years admitted to a participating hospital who had STEMI (International Classification of Disease, Tenth Revision [ICD-10] codes I21.0x, I21.1x, I21.2x, or I21.3x) as primary discharged diagnosis. Data were collected from all 22 Finnish hospitals with angiolaboratory using the Finnish Hospital Discharge Register, a nationwide database maintained by the Finnish National Institute for Health and Welfare. Admissions starting from April

Results

Majority of the patients were men (66.3%; 95% CI 65.5% to 67.3%). The mean age was 67.8 years (SD 12.9, range 30 to 102). Male patients were significantly younger (64.7 ± 12.4 years) than female patients (74.2 ± 11.7 years), p <0.0001. Average duration of admission for STEMI was 6.8 ± 5.2 days. Co-morbidities of patients are listed in Table 1. Women with STEMI had heart failure, diabetes, and systemic connective tissue disease more frequently than men (Table 1). Chronic coronary artery and

Discussion

This multihospital, nationwide study explored potential gender differences of in-hospital mortality in STEMI. We found women to have significantly higher crude in-hospital mortality rate after STEMI compared with men, but this was explainable by differences in age and co-morbidities. Thus, gender by itself did not influence mortality in our study population. Although smaller STEMI studies of in-hospital10, 12 mortality have found comparable results, large majority of previous studies report

Disclosures

This study was supported by grants from the Clinical Research Foundation of the Turku University Hospital and the Finnish Cardiac Society. The authors have no conflicts of interest to disclose.

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Many experimental and clinical studies have indicated that female sex favourably influences remodelling and adaptive response to myocardial infarction [14,19]. While others showed unfavorable differences in prognosis among women with STEMI [20]. Therefore, in the presented study, we conducted additional analyzes to determine if there are any gender differences in the no reflow population.
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Patients with no-reflow phenomenon in infarct related artery after pPCI constitute a more diverse group than previously thought. Some differences are most likely gender-specific. The female sex might have an adverse effect on in-hospital mortality in case of TIMI grade 1 and on the long-term prognosis among patients with TIMI grade 0.
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Little is known about the causality and pathological mechanism underlying the association between old age and myocardial injury in patients with ST-segment elevation myocardial infarction (STEMI). We evaluated the association between old age and myocardial injury in STEMI patients undergoing primary percutaneous coronary intervention (PCI) using cardiovascular magnetic resonance imaging (CMR).
A total of 279 patients with STEMI who underwent primary PCI and CMR were enrolled. Of these, 52 patients were over the age of 70 years (18.6%, Age ≥70 group) and 227 patients were under the age of 70 years (81.4%, Age <70 group) at STEMI occurrence. We compared myocardial infarct size on CMR according to age at STEMI occurrence and performed inverse probability of treatment weighting.
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Coronary Artery DiseaseGender and In-hospital Mortality of ST-Segment Elevation Myocardial Infarction (from a Multihospital Nationwide Registry Study of 31,689 Patients)

Section snippets

Methods

Results

Discussion

Disclosures

Am J Cardiol

Int J Cardiol

Am J Cardiol

Am Heart J

Arch Cardiovasc Dis

Am J Cardiol

Int J Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Am Heart J

Int J Cardiol

Sex differences in mortality following acute coronary syndromes

JAMA

Coronary Artery Disease
Gender and In-hospital Mortality of ST-Segment Elevation Myocardial Infarction (from a Multihospital Nationwide Registry Study of 31,689 Patients)