COMPARISONS OF CHARACTERISTICS AND OUTCOMES AMONG WOMEN AND MEN WITH ACUTE MYOCARDIAL-INFARCTION TREATED WITH THROMBOLYTIC THERAPY

Objective.-To compare baseline characteristics, complications, and tre atment-specific outcomes of women and men with acute myocardial infarc tion treated with thrombolytic therapy. Design.-Randomized controlled trial. Patients and Setting.-A total of 10 315 women and 30 706 men wi th acute myocardial infarction treated in 1081 hospitals in 15 countri es as part of the Global Utilization of Streptokinase and Tissue Plasm inogen Activator for Occluded Coronary Arteries (GUSTO-I). Interventio n.-One of four thrombolytic regimens: (1) streptokinase with subcutane ous heparin; (2) streptokinase with intravenous heparin; (3) streptoki nase plus alteplase (tissue-type plasminogen activator) with intraveno us heparin; or (4) accelerated alteplase with intravenous heparin. Mai n Outcome Measures.-Mortality, stroke, and nonfatal complications duri ng 30-day follow-up. Results.-Women were on average 7 years older than men and delayed 18 minutes (median) longer after symptom onset before presenting to the hospital. After adjustment for age, women more ofte n had a history of diabetes, hypertension, and smoking than men. Time to treatment was significantly longer in women (1.2 vs 1.0 hours; P<.0 01). Women had more nonfatal complications after treatment, including shock (9% vs 5%; P<.001), congestive heart failure (22% vs 14%; P<.001 ), serious bleeding (15% vs 7%; P<.001), and reinfarction (5.1% vs 3.6 %; P<.001). Women had twice as many total strokes as men (2.1% vs 1.2% ; P<.001), secondary to their older age at presentation. The unadjuste d mortality rate was twice as high in women as men (11.3% vs 5.5%; P<. 001); the relative risk (RR) of death was greater among women than men after adjustment for differences in baseline characteristics (RR=1.15 ; 95% confidence interval, 1.0 to 1.31). Although women and men underw ent angiography at similar rates, there were small but significant dif ferences in their rates of revascularization procedures (angioplasty: 35% of women and 32% of men; bypass surgery: 7% of women and 9% of men ; P<.001 for both). The higher rate of stroke in women after treatment with alteplase (2.0% vs 1.9% with streptokinase and intravenous hepar in) was offset by a greater relative reduction in mortality (10.3% vs 11.1%). Conclusion.-Women who received thrombolytic therapy for treatm ent of acute myocardial infarction were at greater risk for both fatal and nonfatal complications than men.