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Influence of gender on treatment and short-term mortality of patients with acute myocardial infarction in Berlin

Geschlechtsspezifische Aspekte in der Behandlung und Krankenhaussterblichkeit von Patientinnen und Patienten mit akutem Myokardinfarkt in Berlin

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Zusammenfassung

Einleitung

Frühere Studien bei Patienten mit akutem Myokardinfarkt zeigten eine höhere Krankenhaussterblichkeit von Frauen, speziell jüngeren Frauen, im Vergleich zu Männern. Da die Behandlung des akuten Myokardinfarktes sich schnell entwickelt und nachdem geschlechtsspezifische Aspekte in den letzten Jahren detailliert diskutiert wurden, war es unser Ziel die Determinanten der Krankenhaussterblichkeit, insbesondere geschlechtsspezifische Aspekte, in Berlin erneut zu untersuchen.

Methoden und Ergebnisse

In einem prospektiven Register wurden die Daten von 5133 Patienten (3330 Männer und 1803 Frauen) mit akutem Myokardinfarkt, welche in den Jahren 1999–2002 in 25 Berliner Krankenhäusern behandelt wurden, gesammelt. Während des Krankenhausaufenthaltes betrug die Gesamtmortalität 18,6% bei den Frauen und 8,4% bei den Männern. Frauen waren älter (mittleres Alter: Männer 62 Jahre, Frauen 73 Jahre) und seltener (noch) verheiratet (Männer 74,6%, Frauen 36,9%) als Männer. Frauen benötigten nach dem Infarktereignis länger bis zum Eintreffen im Krankenhaus (Median: Männer 2,0 h, Frauen 2,6 h) und litten häufiger an Diabetes mellitus (Männer 22,8%; Frauen 36,5%) sowie arterieller Hypertonie (Männer 58,0%; Frauen 69,3%). Eine rekanalisierende Behandlung (Männer 68,8%; Frauen 49,7%) und die Gabe von Betablockern (Männer 76,0%; Frauen 66,0%) wurde bei Frauen seltener angewendet. In einer multivariaten Analyse zeigten sich folgende Parameter als unabhängige Prädiktoren der Krankanhaussterblichkeit: Alter, Geschlecht, Diabetes mellitus, Hypercholesterinämie, vorbestehende Herzinsuffizienz, Reanimation, kardiogener Schock und Lungenstauung bei Aufnahme, Aufnahme in einem Krankenhaus mit mehr als 600 Betten, ST-Streckenhebung im initialen EKG, eine rekanalisierende Therapie, Betablocker und ACE-Hemmer Gabe innerhalb von 48 h nach der Aufnahme.

Schlussfolgerung

Nach Adjustierung in einer multivariaten Analyse zeigen Frauen mit einem akuten Myokardinfarkt weiterhin ein höheres Risiko im Krankenhaus zu sterben als Männer.

Summary

Aims

Previous studies have shown higher hospital mortality rates in women, especially younger women, than in men. In light of the fact that myocardial infarction therapy is rapidly developing, and since gender-specific aspects have been discussed in detail during recent years, it was our goal to re-evaluate factors influencing hospital mortality rate, especially those involving gender-specific differences, in the city of Berlin, Germany.

Methods

We prospectively collected data from 5133 patients (3330 men and 1803 women) with acute myocardial infarction who were treated in 25 hospitals in Berlin during the years 1999 to 2002.

Results

During hospitalization the overall mortality rate was 18.6% among women and 8.4% among men. Women were older (mean age for men 62 years; women 73 years) and less likely to be married (men 74.6%; women 36.9%) than men. Women generally took longer to arrive at the hospital after infarction than did men (median time: men 2.0 h; women 2.6 h). Women furthermore demonstrated a higher proportion of diabetes (men 22.8%; women 36.5%) and hypertension (men 58.0%; women 69.3%). Reperfusion therapy (men 68.8%; women 49.7%) and administration of beta-blockers (men 76.0%; women 66.0%) took place less often for women than for men. A multivariate analysis revealed the following factors to be independent predictors of hospital mortality: age, gender, diabetes mellitus, hypercholesterolemia, pre-existing heart failure, pre-hospital cardiopulmonary resuscitation, cardiogenic shock and pulmonary congestion on admission, admission to a hospital with >600 beds, ST-elevation in the initial ECG, reperfusion therapy, as well as beta-blocker and ACE inhibitor treatment within 48 h of hospitalization.

Conclusion

Even after adjustment in multivariate analysis, women with acute myocardial infarction still demonstrate a higher risk for in-hospital death than men.

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Authors and Affiliations

  1. Universitätsklinikum Charité, Campus Mitte, Medizinische Klinik mit Schwerpunkt Kardiologie, Angiologie, Pneumologie, Schumannstr. 20/21, 10117, Berlin, Germany

    H. Theres

  2. Für das Berliner Herzinfarktregister e. V., Berlin, Germany

    B. Maier, G. Kallischnigg & W. Thimme

  3. Institut für Gesundheitswissenschaften, Technische Universität, Berlin, Germany

    R. Matteucci Gothe & G. Kallischnigg

  4. Klinik für Innere Medizin Kardiologie, Diabetologie und konservative Intensivmedizin, Vivantes-Auguste-Viktoria-Klinikum, Berlin, Germany

    K. P. Schüren

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  1. H. Theres
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  2. B. Maier
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For the Berliner Herzinfarktregister e. V. *, Berlin, Germany

Corresponding author

Correspondence to H. Theres.

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* For a complete list of primary investigators and participating hospitals see appendices

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Theres, H., Maier, B., Matteucci Gothe, R. et al. Influence of gender on treatment and short-term mortality of patients with acute myocardial infarction in Berlin. Z Kardiol 93, 954–963 (2004). https://doi.org/10.1007/s00392-004-0157-2

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  • DOI: https://doi.org/10.1007/s00392-004-0157-2

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