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

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 fibrinotysis 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. © 2003 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

Full Text

Duke Authors

Cited Authors

  • Tjandrawidjaja, MC; Fu, Y; Goodman, SG; Werf, FVD; Granger, CB; Armstrong, PW

Published Date

  • 2003

Published In

  • European Heart Journal

Volume / Issue

  • 24 / 11

Start / End Page

  • 1024 - 1034

PubMed ID

  • 12788302

Digital Object Identifier (DOI)

  • 10.1016/S0195-668X(03)00082-4