GENDER AND ACUTE MYOCARDIAL-INFARCTION - IS THERE A DIFFERENT RESPONSE TO THROMBOLYSIS

Objectives. This study sought to 1) determine the effect of gender on early and late infarct related artery patency and reocclusion after th rombolytic therapy for acute myocardial infarction; 2) examine the eff ect of gender on left ventricular function in response to injury/reper fusion; and 3) assess the independent contribution of gender to early (30-day) mortality after acute myocardial infarction. Background. Wome n have a higher mortality rate than men after myocardial infarction. H owever, the effect of gender on infarct-related coronary artery patenc y and left ventricular response to injury/reperfusion have not been fu lly defined in the thrombolytic era. Methods. Patency rates and global and regional left ventricular function were determined in patients at 90 min and 5 to 7 days after thrombolytic therapy for acute myocardia l infarction. The effect of gender on infarct-related artery patency a nd left ventricular function was determined. Thirty-day mortality diff erences between women and men were compared. Results. Women were signi ficantly older and had more hypertension, diabetes, hypercholesterolem ia, heart failure and shock They were less likely to have had a previo us myocardial infarction, history of smoking or previous bypass surger y. Ninety-minute patency rates (Thrombolysis in Myocardial Infarction [TIMI] flow grade 3) in women and men were 39% and 38%, respectively ( p = 0.5). Reocclusion rates were 8.7% in women versus 5.1% in men (p = 0.14). Women had more recurrent ischemia than men (21.4% vs. 17.0%, r espectively, p = 0.01). Ninety minute ejection fraction and regional v entricular function were clinically similar in women and men with TIMI 2 or 3 flow (ejection fraction [mean +/- SD]: 63.4 +/- 6% vs. 59.4 +/ - 0.7%, p = 0.02; number of chords: 21.4 +/- 0.9 vs. 21.0 +/- 1.9, p = 0.7; SD/chord: -2.4 +/- 08 vs. -2.4 +/- 0.2, p = 0.9, respectively). No clinically significant differences in left ventricular function wer e noted at 5- to 7-day follow-up. Women had a greater hyperkinetic res ponse than men in the noninfarct zone (SD/chord: 2.4 +/- 0.2 vs. 1.7 /- 0.1, p = 0.005). The 30-day mortality rate was 13.1% in women versu s 4.8% in men (p less than or equal to 0.0001). After adjustment for o ther clinical and angiographic variables, gender remained an independe nt determinant of 30-day mortality. Conclusions. Women do not differ s ignificantly from men with regard to either early infarct-related arte ry patency rates or reocclusion after thrombolytic therapy or ventricu lar functional response to injury/reperfusion. Gender was an independe nt determinant of 30-day mortality after acute myocardial infarction.