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Influence of gender on the risk of death and adverse events in patients with acute myocardial infarction undergoing pharmacoinvasive strategy

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Abstract

Pharmacoinvasive treatment is an acceptable alternative for patients with ST-segment elevation myocardial infarction (STEMI) in developing countries. The present study evaluated the influence of gender on the risks of death and major adverse cardiovascular events (MACE) in this population. Seven municipal emergency rooms and the Emergency Mobile Healthcare Service in São Paulo treated STEMI patients with tenecteplase. The patients were subsequently transferred to a tertiary teaching hospital for early (<24 h) coronary angiography. A total of 469 patients were evaluated [329 men (70.1 %)]. Compared to men, women had more advanced age (60.2 ± 12.3 vs. 56.5 ± 11 years; p = 0.002); lower body mass index (BMI; 25.85 ± 5.07 vs. 27.04 ± 4.26 kg/m2; p = 0.009); higher rates of hypertension (70.7 vs. 59.3 %, p = 0.02); higher incidence of hypothyroidism (20.0 vs. 5.5 %; p < 0.001), chronic renal failure (10.0 vs. 8.8 %; p = 0.68), peripheral vascular disease (PVD; 19.3 vs. 4.3 %; p = 0.03), and previous history of stroke (6.4 vs. 1.3 %; p = 0.13); and higher thrombolysis in myocardial infarction risk scores (40.0 vs. 23.7 %; p < 0.001). The overall in-hospital mortality and MACE rates for women versus men were 9.3 versus 4.9 % (p = 0.07) and 12.9 versus 7.9 % (p = 0.09), respectively. By multivariate analysis, diabetes (OR 4.15; 95 % CI 1.86–9.25; p = 0.001), previous stroke (OR 4.81; 95 % CI 1.49–15.52; p = 0.009), and hypothyroidism (OR 3.75; 95 % CI 1.44–9.81; p = 0.007), were independent predictors of mortality, whereas diabetes (OR 2.05; 95 % CI 1.03–4.06; p = 0.04), PVD (OR 2.38; 95 % CI 0.88–6.43; p = 0.08), were predictors of MACE. In STEMI patients undergoing pharmacoinvasive strategy, mortality and MACE rates were twice as high in women; however, this was due to a higher prevalence of risk factors and not gender itself.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

    Eduardo Lanaro, Adriano Caixeta, Juliana A. Soares, Cláudia Maria Rodrigues Alves, Adriano Henrique Pereira Barbosa, José Augusto Marcondes Souza, José Marconi Almeida Sousa, Amaury Amaral, Guilherme M. Ferreira, Antônio Célio Moreno, Iran Gonçalves Júnior, Edson Stefanini & Antônio Carlos Carvalho

  2. Department of Cardiovascular Interventions, Hospital São Paulo, Rua Napoleão de Barros, 715, São Paulo, SP, 04024-002, Brazil

    Adriano Caixeta

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  1. Eduardo Lanaro
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  2. Adriano Caixeta
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  3. Juliana A. Soares
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  4. Cláudia Maria Rodrigues Alves
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  5. Adriano Henrique Pereira Barbosa
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Correspondence to Adriano Caixeta.

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Eduardo Lanaro and Adriano Caixeta contributed equally to this manuscript.

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Lanaro, E., Caixeta, A., Soares, J.A. et al. Influence of gender on the risk of death and adverse events in patients with acute myocardial infarction undergoing pharmacoinvasive strategy. J Thromb Thrombolysis 38, 510–516 (2014). https://doi.org/10.1007/s11239-014-1072-7

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  • DOI: https://doi.org/10.1007/s11239-014-1072-7

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