The impact of gender on the treatment and outcomes of patients with early reinfarction after fibrinolysis: insights from ASSENT-2.

Published

Journal Article

AIMS: To assess gender differences in patients with early reinfarction after fibrinolysis for acute myocardial infarction (AMI) and the impact of these differences on treatment and outcomes. METHODS AND RESULTS: We studied 3.7% of men (n=481) and 4.8% of women (n=189) with early reinfarction after fibrinolysis for AMI in the ASSENT-2 trial of 16,949 patients. Women with reinfarction were older and more often had hypertension, diabetes, and major bleeding prior to reinfarction. Despite adjustment for these differences, women with reinfarction were less likely to receive repeat fibrinolytic therapy (OR: 0.55; 95% CI: 0.37-0.84). Aggressive treatment by either repeat fibrinolysis or urgent revascularization was associated with reduced 1-year mortality irrespective of gender. Death within 24 h of reinfarction was more frequent in women and accounted for a greater proportion of their 1-year mortality (56.0 vs 34.8%; p=0.02). The excess mortality in women at 1 year (27.3 vs 19.9%; p=0.045) was eliminated after adjustment for gender differences in baseline risk profile. CONCLUSION: Women with early reinfarction following fibrinolysis for AMI had more frequent early death and were managed less aggressively. These findings suggest the need for increased awareness and timely intervention in these patients.

Full Text

Duke Authors

Cited Authors

  • Tjandrawidjaja, MC; Fu, Y; Goodman, SG; Van de Werf, F; Granger, CB; Armstrong, PW; ASSENT-2 Investigators,

Published Date

  • June 2003

Published In

Volume / Issue

  • 24 / 11

Start / End Page

  • 1024 - 1034

PubMed ID

  • 12788302

Pubmed Central ID

  • 12788302

International Standard Serial Number (ISSN)

  • 0195-668X

Digital Object Identifier (DOI)

  • 10.1016/s0195-668x(03)00082-4

Language

  • eng

Conference Location

  • England