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Previous Volume 341:226-232 July 22, 1999 Number 4 Next

	Full Text PDF Editorial by Wexler, L. F. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Studies have reported that women with acute myocardial infarction have in-hospital and long-term outcomes that are worse than those of men.

Methods To assess sex-based differences in presentation and outcome, we examined data from the Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb study, which enrolled 12,142 patients (3662 women and 8480 men) with acute coronary syndromes, including infarction with ST-segment elevation, infarction with no ST-segment elevation, and unstable angina.

Results Overall, the women were older than the men and had significantly higher rates of diabetes, hypertension, and prior congestive heart failure. They had significantly lower rates of prior myocardial infarction and were less likely ever to have smoked. A smaller percentage of women than men had infarction with ST elevation (27.2 percent vs. 37.0 percent, P<0.001), and of the patients who presented with no ST elevation (those with myocardial infarction or unstable angina), fewer women than men had myocardial infarction (36.6 percent vs. 47.6 percent, P<0.001). Women had more complications than men during hospitalization and a higher mortality rate at 30 days (6.0 percent vs. 4.0 percent, P<0.001) but had similar rates of reinfarction at 30 days after presentation. However, there was a significant interaction between sex and the type of coronary syndrome at presentation (P=0.001). After stratification according to coronary syndrome and adjustment for base-line variables, there was a nonsignificant trend toward an increased risk of death or reinfarction among women as compared with men only in the group with infarction and ST elevation (odds ratio, 1.27; 95 percent confidence interval, 0.98 to 1.63; P=0.07). Among patients with unstable angina, female sex was associated with an independent protective effect (odds ratio for infarction or death, 0.65; 95 percent confidence interval, 0.49 to 0.87; P=0.003).

Conclusions Women and men with acute coronary syndromes had different clinical profiles, presentation, and outcomes. These differences could not be entirely accounted for by differences in base-line characteristics and may reflect pathophysiologic and anatomical differences between men and women.

Source Information

From St. Luke's–Roosevelt Hospital Center and Columbia University, New York (J.S.H., J.E.T.); the Duke Clinical Research Institute, Durham, N.C. (T.D.T., R.M.C.); Henry Ford Heart and Vascular Institute, Detroit (W.D.W.); Green Lane Hospital, Auckland, New Zealand (H.D.W.); University Hospital Gasthuisberg, Leuven, Belgium (F.V.); Flinders Medical Centre, Adelaide, Australia (P.A.); and the Cleveland Clinic Foundation, Cleveland (E.J.T.).

Address reprint requests to Dr. Hochman at St. Luke's–Roosevelt Hospital Center, 1111 Amsterdam Ave., New York, NY 10025.

Full Text of this Article

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N Engl J Med 1999; 341:1931-1935, Dec 16, 1999. Correspondence

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