AFTER CORRECTING FOR WORSE BASE-LINE CHARACTERISTICS, WOMEN TREATED WITH THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION HAVE THE SAMEMORTALITY AND MORBIDITY AS MEN EXCEPT FOR A HIGHER INCIDENCE OF HEMORRHAGIC STROKE

Background. In the prethrombolytic era, women with myocardial infarcti on were reported to have a worse outcome than men. This analysis evalu ates the association of sex with morbidity and mortality after thrombo lytic therapy. Methods and Results. Data were analyzed from 8261 of th e 8387 randomized patients with acute myocardial infarction who receiv ed thrombolytic therapy in the International Tissue Plasminogen Activa tor/Streptokinase Mortality Study (baseline data were missing for 126 patients) and were followed for 6 months. Women made up 23% (n = 1944) of the study population. Baseline characteristics were worse in women : they were 6 years older, were more likely to have a history of previ ous infarction (P<.01), antecedent angina (P<.01), hypertension (P<.00 01), or diabetes (P<.0001); were in a higher Killip class on admission (P<.0002); and received thrombolytic therapy 18 minutes later than me n (P<.0001). Fewer women were smokers (P<.0001). Women had a higher ho spital (12.1% versus 7.2%, P<.0001) and 6-month mortality (16.6% versu s 10.4%, P<.0001) and were more likely to develop cardiogenic shock (9 .1% versus 6.3%, P<.0001), bleeding (7.2% versus 5.3%, P<.01), and hem orrhagic (1% versus 0.3%, P<.001) or total stroke (2.2% versus 1.1%, P <.0001) during hospitalization. Reinfarction rates and requirement for angioplasty or surgery did not differ. After correction for worse bas eline characteristics, women had similar morbidity and mortality apart from a significantly higher incidence of hemorrhagic stroke, which re mained significant even after accounting for weight and treatment allo cation (odds ratio, 2.90; P<.01). Conclusions. After thrombolytic ther apy for acute myocardial infarction, women have similar morbidity and mortality to men but suffer from a higher incidence of hemorrhagic str oke.