Although overall in-hospital mortality rates following a heart attack are similar for men and women, women who suffer a severe type of heart attack called an ST-elevation myocardial infarction (STEMI) face a worse prognosis than men, investigators report in the current issue of Circulation. Failure to administer appropriate and timely treatment to women appears to account for gender disparity in outcomes.
In a STEMI, there is a high likelihood that the affected coronary artery is completely blocked by a clot, which causes the portion of the heart muscle supplied by the artery to begin to die. This type of heart attack gets its name by the changes it produces on the ECG, one being an elevation in the “ST segment”. The ST segment elevation indicates that a large amount of damage to the heart muscle is occurring.
Earlier studies indicated that women were less likely than men to survive a heart attack, the research team notes. To see if this “mortality gap” still exists, Dr Hani Jneid, at Baylor College of Medicine in Houston, and fellow researchers analysed data from the American Heart Association’s Get With The Guidelines – Coronary Artery Disease registry.
The study population included approximately 78,000 heart attack patients (39 percent female) admitted to 420 US hospitals between 2001 and 2006; a STEMI was detected in about 33 per cent.
The mortality rate for overall heart attack mortality was higher among women than among men (8.2 per cent vs 5.7 per cent) and about twice as high in patients with a STEMI, the report indicates.
After factoring in the effect of sociodemographic and clinical factors, the investigators found that the overall gender difference in heart attack mortality was no longer statistically significant.
However, in-hospital mortality rates remained significantly higher among women with a STEMI.
“The residual sex-based disparity in adjusted in-hospital mortality rates after STEMI was accounted for by an excess of very early deaths (in the initial 24 hours of hospitalisation) among STEMI women, who appeared to receive less invasive procedures and revascularisation during this time period," Dr Jneid’s team writes.
The investigators also found the women were less likely than men to be given early treatment with aspirin, beta blockers, or to receive reperfusion therapy. Women also underwent fewer cardiac catheterisation procedures or any type of revascularisation.
The evidence that the current treatment guidelines for treating a heart attack are not being followed for female patients, and the reperfusion is delayed in women compared with men, highlights areas of women’s healthcare that need improvement, the investigators conclude.
Reuters Health
Source: Circulation, December 2008.