Impact of Gender on Treatment and Clinical Outcomes in Acute ST Elevation Myocardial Infarction Patients in Thailand
Boonchu Srichaiveth MD*, Permyos Ruengsakulrach MD, PhD*, Kitipan Visudharom MD, PhD*, Sopon Sanguanwong MD**, Wiwun Tangsubutr MD***, Pattanapong Insamian MPH****
Affiliation : * Bangkok Heart Hospital, Thailand ** Phramongkutklao Hospital, Thailand *** Siriraj Hospital, Faculty of Medicine, Thailand **** Cardiovascular Research Center, The Heart Association of Thailand under the Royal Patronage of H.M. the King
Background : Coronary heart disease is the leading cause of mortality and morbidity in men as well as in women. Women
have their first cardiac event 6 to 10 years later than men do. Whereas, the cardiovascular death rates are declining in men,
they remain constant in women. In cardiovascular studies with age limits, women are naturally the minority, amounting to < 40%.
Objective : Determine the effect of gender on treatment and clinical outcomes in acute ST elevation myocardial infarction
(STEMI) patients.
Materials and Methods : This is a multicenter study including 13 government and 4 private institutions. Between August 1, 2002
and October 31, 2005, 3,836 consecutive patients with ST elevation myocardial infarction were enrolled. The patient
characteristics, treatment, and hospital outcome were collected and validated. In-hospital management and outcomes were
compared between men and women, without adjustment, with adjustment for age alone and with adjustment for age and other
covariates by means of multivariate stepwise logistic regression analysis. In each model tested, gender was forced into the
model, whereas other predictors were selected in a stepwise manner.
Results : Women were 1,223 patients (31.9%) of all patients and were 8 years older than men (67.5 + 12.0 vs. 59.7 + 12.4
years).Women had a higher incidence of diabetes and hypertension (46.9% vs. 31.0%, p < 0.001 and 62.1% vs. 45.3%, p <
0.001). Smoking and family risk factor were found in men more than in women (17.5% vs. 52.5%, p < 0.001 and 7.4% vs.
11.2%, p < 0.001). Women presented more frequently with cardiac dyspnea and shock than men (35.3% vs. 22.2%, p < 0.001
and 21.5% vs. 13.8%, p < 0.001). There was no difference in time to admission between men and women. Beta blocker, statin,
angiotensin converting enzyme inhibitor (ACEI) and angiotensin II receptor inhibitor (ARB) were less frequently used in
women. Coronary angiogram was performed less often in women and less abnormal angiogram were found (57.8% vs.
65.0%, p < 0.001 and 55.5% vs. 63.9%, p < 0.001). A lower percentage of women received thrombolytic therapy (28.1% vs.
31.4%, p = 0.039) as well as percutaneous coronary intervention (PCI) (39.0% vs. 48.5%, p < 0.001).Unadjusted in-
hospital mortality was significantly higher in women than in men (23.6% vs. 13.9%, unadjusted OR (95% CI) 1.90 (1.60-
2.26), p < 0.001). After adjustment of other covariables (age group > 75 years, hospital group (metropolitan, regional), chest
pain, cardiac dyspnea, shock, post cardiac arrest, diabetes, hypertension, family history, smoking, dyslipidemia, refer, time
to admission < 12 hours (hour), aspirin, beta blocker, calcium antagonist, statin, ACEI, ARB, nitrate, coronary angiogram,
thrombolysis, PCI, coronary artery bypass grafting, congestive heart failure, arrhythmia, stroke, bleeding), the gender
difference in-hospital mortality no longer existed (adjusted OR (95% CI) 1.03 (0.80-1.33), p = 0.814). The incidence of
congestive heart failure as a complication was significantly higher in women than in men (55.6% vs. 38.7%, p < 0.001,
adjusted OR (95% CI) 1.29 (1.08-1.54), p = 0.005).
Conclusion : Women with acute ST elevation myocardial infarction were older and had a higher incidence of hypertension
and diabetes than men. Women were less likely than men to undergo coronary angioplasty. Women in the authors’ registry had
a higher risk for in-hospital morbidity and mortality than men. Early and aggressive treatment might improve the clinical
outcomes in women with STEMI.
Keywords : Gender, STEMI, Treatment, Clinical outcomes
