PMID- 18431888
OWN - NLM
STAT- MEDLINE
DCOM- 20080521
LR  - 20140730
IS  - 0125-2208 (Print)
IS  - 0125-2208 (Linking)
VI  - 90 Suppl 1
DP  - 2007 Oct
TI  - Impact of gender on treatment and clinical outcomes in acute ST elevation 
      myocardial infarction patients in Thailand.
PG  - 65-73
AB  - 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. MATERIAL AND METHOD: 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 < or = 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.
FAU - Srichaiveth, Boonchu
AU  - Srichaiveth B
AD  - Bangkok Heart Hospital, Bangkok, Thailand.
FAU - Ruengsakulrach, Permyos
AU  - Ruengsakulrach P
FAU - Visudharom, Kitipan
AU  - Visudharom K
FAU - Sanguanwong, Sopon
AU  - Sanguanwong S
FAU - Tangsubutr, Wiwun
AU  - Tangsubutr W
FAU - Insamian, Pattanapong
AU  - Insamian P
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - Thailand
TA  - J Med Assoc Thai
JT  - Journal of the Medical Association of Thailand = Chotmaihet thangphaet
JID - 7507216
SB  - IM
MH  - Acute Disease
MH  - Age Factors
MH  - Aged
MH  - Angioplasty, Balloon, Coronary
MH  - Diabetes Mellitus
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Hypertension
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*drug therapy/epidemiology/mortality
MH  - Registries
MH  - Risk Factors
MH  - Sex Factors
MH  - Smoking
MH  - Thailand/epidemiology
MH  - *Treatment Outcome
EDAT- 2008/04/25 09:00
MHDA- 2008/05/22 09:00
CRDT- 2008/04/25 09:00
PHST- 2008/04/25 09:00 [pubmed]
PHST- 2008/05/22 09:00 [medline]
PHST- 2008/04/25 09:00 [entrez]
PST - ppublish
SO  - J Med Assoc Thai. 2007 Oct;90 Suppl 1:65-73.