HOSPITAL MORTALITY IN WOMEN AND MEN WITH ACUTE CARDIAC ISCHEMIA - A PROSPECTIVE MULTICENTER STUDY

Objectives. This study sought to determine gender differences in hospi tal mortality in patients with acute cardiac ischemia. Background. It is unclear why women experience higher mortality from acute myocardial infarction (AMI) than men and whether this applies to all patients wi th acute ischemia. Methods. We analyzed data from a prospective multic enter study involving patients presenting to the emergency department (ED) with symptoms suggestive of acute ischemia. Results. Of 10,783 pa tients, 5,221 (48.4%) were women. Mean age was 60.5 years for women an d 56.9 for men (p < 0.001). Women had more hypertension (54.6% vs, 45. 9%, p < 0.001) and diabetes (23.3% vs, 17.0%, p < 0.001) than men but fewer previous AMIs (21.1% vs. 28.9%, p < 0.001), Acute ischemia was c onfirmed in 1,090 women (20.8%) and 1,451 men (26.1%, p < 0.001), incl uding AMI in 322 women (6.2%) and 572 men (10.3%, p < 0.001). Women wi th an AMI were in a higher Killip class than men: class I in 60.3% ver sus 72.2%, class II in 19.3% versus 16%, class III in 15.5% versus 8.7 % and class IV in 5% versus 3.1%, respectively (p = 0.001), There was no significant difference in mortality from acute ischemia between gen ders (4.0% vs. 3.5%, p = 0.6), but there was a trend for higher AMI mo rtality in women (10.3% vs. 7.4%, p = 0.1). After controlling for age, diabetes, heart failure and presenting blood pressure, gender did not predict mortality from acute ischemia (odds ratio 0.9, 95% confidence interval 0.5 to 1.4, p = 0.5). Conclusions. Among patients presenting to the ED with acute cardiac ischemia, gender does not appear to be a n independent predictor of hospital mortality, The trend for higher mo rtality in women from AMI can be explained by their older age, greater frequency of diabetes and higher Killip class on presentation. (C) 19 97 by the American College of Cardiology.