Determinants of in-hospital mortality in women with acute myocardial infarction who underwent primary coronary angioplasty

Abstract

Introduction: According to recent data, women have a greater risk of dying from an acute coronary event. The determinants of this ominous prognosis are not completely understood. Preliminary analysis of our data suggested that this poorer prognosis is also observed in the subgroup of patients with acute myocardial infarction submitted to direct coronary angioplasty (PTCA). This finding prompted us to investigate gender differences and their determinants in this particular context.

Objective: To identify risk factors associated with the greater in-hospital mortality of women with acute infarction who underwent PTCA.

Methods: One hundred and forty-five consecutive patients with acute myocardial infarction who underwent direct PTCA in the same hospital were studied retrospectively. Data were collected from the database of the catheterisation laboratory and from clinical files. The following parameters were analysed: in-hospital mortality, age, prevalence of diabetes mellitus, history of coronary heart disease, time elapsed from beginning of symptoms to coronary intervention, peak values of CK and MB-CK, number of coronary arteries with significant disease at angiography, culprit lesion localisation, and prevalence of shock on admission. For statistical analysis, cross-tabulation (Pearson x2) and comparison of means (Student's t test) were employed when appropriate; an error of 5% was admitted for the rejection of the null hypothesis.

Results: Women (n = 39) represented 26.9% of sample. In hospital mortality was 28.2% (n = 11) for women and 11.3% (n = 12) for men (p = 0.014). The prevalence of coronary heart disease before the current acute event, the time elapsed from beginning of symptoms to coronary intervention, and maximum values of CK and MB-CK were similar in both genders. Differences between women and men were found as regards the following variables (women vs men): age (61.7 +/- 10 vs 56.1 +/- 12.6 years), prevalence of left main disease (15.3 vs 1.9%) and prevalence of shock (41 vs 17%) and diabetes (38.7 vs 13.6%). Considering women and men who died, only disease severity as evaluated by the number of vessels involved distinguished both genders (p = 0.05).

Conclusions: In our experience, women admitted with acute myocardial infarction and treated by direct PTCA are, on average, older than men and have a greater prevalence of shock at admission, of left main disease and of diabetes, and more severe coronary artery disease. In the present series and as regard in-hospital mortality, disease severity as evaluated by the number of vessels involved is the only variable that discriminates women from men.