LONG-TERM FOLLOW-UP OF GENDER-SPECIFIC OUTCOMES AFTER THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION FROM THE GUSTO-I TRIAL

Our objective was to assess gender differences in mortality 1 year aft er acute myocardial infarction (MI). The Global Utilization of Strepto kinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial database of 41,021 patients with suspected acute MI w as used to generate 1-year Kaplan-Meier survival plots. Risk quartiles and mortality of women and men were compared. The unadjusted 1-year m ortality rate for the initial GUSTO-I population and 30-day survivors demonstrates a large gender gap [odds ratio for all patients = 2.2, 95 % confidence interval (CI), 2.0-2.3, p < 0.001]. For the initial popul ation, when adjusted for age, the gender gap is still apparent (odds r atio = 1.4, 95%, CI = 1.3-1.5, p < 0.001) although no longer significa nt when adjusted using the 30-day survival model (odds ratio = 1.06, 9 5% CI = 0.97-1.15, p < 0.001). For the 30-day survivors, adjustment ba sed on age alone explained the 1-year mortality difference (risk ratio = 0.96, 95% CI 0.85-1.07, p = 0.441). When the population was divided into expected risk quartiles, women were more likely to fall into the higher expected risk quartiles, even after adjusting for age. A gende r gap after acute MI is apparent, nearly all of which occurs within th e first 30 days. A substantial portion of the gender gap is explained by the increased age of women, and the rest of the gap may be attribut ed to differences in variables predictive of 30-day mortality. During 1-year follow-up, the late mortality of women is no greater than that of age-matched men.