GENDER-RELATED DIFFERENCES IN REPERFUSION TREATMENT ALLOCATION AND OUTCOME FOR ACUTE MYOCARDIAL-INFARCTION

Gender-related differences in outcome after myocardial infarction may relate to biased treatment allocation. To address this concern we anal yzed 573 patients presenting with ST-segment elevation acute myocardia l infarction (AMI), and treated within 6 hours with reperfusion therap y. Two-hundred eighty patients (49%) received direct coronary angiopla sty, whereas 293 (51%) received thrombolytics followed by angioplasty (p = NS). Seventy-four percent were men and 26% were women (p = NS for differences in sex distribution between the 2 treatment groups). Wome n were older in both groups (p <0.01). Inferior AMI was seen more ofte n in women (64% of direct angioplasty, 71% of lytic first) than in men (51% and 59%, respectively; p <0.03). There was no gender-related dif ference in presence of multivessel coronary artery disease, prior AMI, prior bypass surgery, baseline election fraction, percentage of patie nts with ejection fraction less than or equal to 40%, number of narrow ings dilated, or angioplasty success. Patients who underwent direct an gioplasty had more multivessel disease (p <0.001) and prior coronary a rtery bypass surgery (p = 0.002). After a mean follow-up of 129 +/- 11 3 weeks, no gender-related differences were seen In the need for cardi ac catheterization, documented restenosis, AMI, coronary artery bypass surgery, clinical ischemia, or death. Patients treated with direct an gioplasty were more likely to undergo coronary artery bypass surgery ( p <0.05) or to die (p <0.01). Thus, women undergoing reperfusion thera py for ST-segment elevation were older than men, with a higher frequen cy of inferior wall AMI. No specific gender-related bias in treatment allocation was evident.