Circulation, Vol 88, 2097-2103, Copyright © 1993 by American Heart Association
HD White, GI Barbash, M Modan, J Simes, R Diaz, JR Hampton, J Heikkila, A Kristinsson, S Moulopoulos and EA Paolasso
BACKGROUND. In the prethrombolytic era, women with myocardial infarction
were reported to have a worse outcome than men. This analysis evaluates the
association of sex with morbidity and mortality after thrombolytic therapy.
METHODS AND RESULTS. Data were analyzed from 8261 of the 8387 randomized
patients with acute myocardial infarction who received thrombolytic therapy
in the International Tissue Plasminogen Activator/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 previous infarction (P < .01), antecedent
angina (P < .01), hypertension (P < .0001), or diabetes (P <
.0001); were in a higher Killip class on admission (P < .0002); and
received thrombolytic therapy 18 minutes later than men (P < .0001).
Fewer women were smokers (P < .0001). Women had a higher hospital (12.1%
versus 7.2%, P < .0001) and 6-month mortality (16.6% versus 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
hemorrhagic (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 baseline characteristics, women had similar morbidity and mortality
apart from a significantly higher incidence of hemorrhagic stroke, which
remained significant even after accounting for weight and treatment
allocation (odds ratio, 2.90; P < .01). CONCLUSIONS. After thrombolytic
therapy for acute myocardial infarction, women have similar morbidity and
mortality to men but suffer from a higher incidence of hemorrhagic stroke.
ARTICLES
After correcting for worse baseline characteristics, women treated with thrombolytic therapy for acute myocardial infarction have the same mortality and morbidity as men except for a higher incidence of hemorrhagic stroke. The Investigators of the International Tissue Plasminogen Activator/Streptokinase Mortality Study
Cardiology Department, Green Lane Hospital, Epsom, Auckland, New Zealand.
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