Being female 'independent risk factor' for bleeding, death in

jk1688

24 October 2007

MedWire News: Being a woman is an independent risk factor for death and bleeding complications among myocardial infarction (MI) patients treated with fibrinolytic drugs, a study shows.

The findings indicate that gender differences in MI complications and mortality cannot be explained by baseline variables, and rule out underuse of reperfusion therapy as a possible cause, since all patients in the study received thrombolytic therapy.

Harmony Reynolds (New York University School of Medicine, USA) and team evaluated gender differences in presentation, management, and outcomes in GUSTO (Global Use of Strategies to Open Occluded arteries in Acute Coronary Syndromes) V.

The study enrolled 16,588 MI patients who were randomly assigned to receivestandard-dose reteplase or standard-dose abciximab plus half-dose reteplase.

Women were referred significantly less often than men for coronary angiography (37.8% vs 42.3%, p<0.001) and percutaneous coronary intervention (PCI; 23.9% vs 27.6%, p<0.001).

At 30 days, women had a higher mortality than men (9.8% vs 4.4%, p<0.001). After adjusting for other univariate predictors, including age, race, body mass index, blood pressure, treatment received, medical history, family history of coronary heart disease, and Killip class, female gender was associated with twice the odds of death at 30 days (odds ratio [OR]=2.00, p<0.001).

Among the tested variables, only Killip class was associated with a higher OR for death at 30 days.

Women also had a higher risk for death between 30 days and 1 year than men (3.8% vs 2.5%, p<0.01), and multivariate analysis showed that female gender was an independent predictor for death at 7 days (OR=1.61) and at 1 year (hazard ratio=1.14, p=0.03).

Furthermore, women had a much greater risk for moderate and severe bleeding events than men (25.2% vs 14.4%, p<0.01), and female gender was significantly associated with bleeding (OR=1.31, p<0.001). This remained true irrespective of treatment assignment.

The authors conclude: \"Female sex is independently associated with death and bleeding complications among fibrinolytic-treated patients with MI. There remains a sex differential in the use of angiography and, therefore, PCI after fibrinolysis.\"

They add: \"Further research will determine what mediates excess risk in women.\"

Arch Intern Med 2007; 167: 2054-2060