Older women less likely to receive angioplasty, have higher mortality rate after acute MI

American College of Cardiology 59th Annual Scientific Session

ATLANTA – Older women were significantly less likely to receive angiography or angioplasty and almost twofold more likely to die within one month of an acute MI when compared with men, according to new study results.

"We have known for many years that, as compared with men, women have a 40%-100% higher mortality rate after an acute MI and that this mortality is reduced after confounding for age and other comorbidities," Francois Schiele, MD, professor of cardiology and chief of cardiology at the University Hospital of Besancon, France, said during a presentation here. "Comparison of baseline characteristics shows that comorbidities explain the lower use of treatments. Nevertheless, women are less often submitted to coronary angiography and STEMI and have higher in-hospital mortality."

Schiele and colleagues assessed whether the difference in mortality following an acute MI between men and women could be explained by differences in the types of treatment received. The researchers pooled data on 3,510 patients (32% women) treated for an acute MI between January 2006 and December 2007 who were included in a regional registry. Two propensity scores were utilized. Researchers created groups of men and women matched according to baseline characteristics (n=1,298). For the second set of matched pairs, the researchers took into account baseline characteristics and the types of treatments received (n=1,168).

On average, women were aged 10 years older than men, were more likely to have diabetes (27% vs. 21%) and hypertension (68% vs. 48%), received less effective treatments for an acute MI, and were almost twofold more likely to die in the hospital setting (9.7% vs. 5%) or within 30 days of hospital discharge (12.4% vs. 7%) when compared with men. Significant interactions were also found with age, and the gender difference in mortality was significant for patients aged 68 years and older.

One potential explanation was the rate of use of invasive strategies; matched on clinical characteristics, men were 57% more likely than women to undergo coronary angiography. Among patients who had STEMI, men were far more likely than women to receive therapy to reopen the blocked artery, whether by clot-busting drugs (used 72% more often in men) or by angioplasty (used 24% more in men). – by Jennifer Southall

These data have confirmed previous findings suggesting that women are dying sooner after acute MI, women are older when presenting with MI and that we are still seeing fewer procedures in women than men with CAD. Yet, it is comforting that we are seeing similar treatments being performed in men and women. We know that women are older, on average, when they present with MI; I wonder if younger women, in particular those aged younger than 50 years, have a more virulent disease. It is suggested that the atherosclerosis we see in younger women is more virulent, much like the breast cancer we see in younger women, and so I wonder if the same phenomenon is going on with CAD in these women.

There are pretty consistent data that women have higher procedural complications and more bleeding complications than men, which could be limiting some of the invasive treatments. We also do not know if women are refusing the treatments or if the physician did not actually offer it, as we cannot obtain these data from the databases.

– Rita F. Redberg, MD

Cardiology Today Editorial Board

For more information:

Schiele F. LBCT III. Presented at: American College of Cardiology 59th Annual Scientific Sessions; March 13-16, 2010; Atlanta.

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