Comparison of Incidence of Bleeding and Mortality of Men Versus Women With ST-Elevation Myocardial Infarction Treated With Fibrinolysis

详细信息    查看全文

• 作者：Rajendra H. Mehta ; MD ; MS^a ; ^{mehta007@dcri.duke.edu} ; Amanda S. Stebbins ; MS^a ; Renato D. Lopes ; MD ; PhD^a ; Robert M. Califf ; MD^a ; Karen S. Pieper ; MS^a ; Paul W. Armstrong ; MD^b ; Frans Van de Werf ; MD ; PhD^c ; Judith S. Hochman ; MD^d ; Harvey D. White ; MD ; DSc^e ; Eric J. Topol ; MD^f ; John H. Alexander ; MD ; MS^a ; Christopher B. Granger ; MD^a
• 刊名：The American Journal of Cardiology
• 出版年：2012
• 出版时间：1 February 2012
• 年：2012
• 卷：109
• 期：3
• 页码：320-326
• 全文大小：945 K

文摘

Gender-related differences in the incidence of bleeding and its relation to subsequent mortality in patients with ST-segment elevation myocardial infarction (STEMI) treated with fibrinolysis are not well understood. We studied patients with STEMI receiving fibrinolysis enrolled in 6 clinical trials. Outcomes included moderate or severe bleeding defined using Global Utilization of Strategies to Open Occluded Arteries (GUSTO) criteria and adjusted 1-year mortality (excluding deaths in first 24 hours). Moderate or severe bleeding was 1.9-fold higher in women compared to men (13.3 % vs 7.1 % , p <0.0001). Bleeding remained higher in women even after adjustment for baseline differences (odd ratios 1.52, 95 % confidence interval [CI] 1.42 to 1.62). In fact, female gender was second most important prognostic factor (Wald chi-square 153.6) after older age (Wald chi-square 241.2) in the multivariable bleeding model. Overall 1-year mortality was similar in women and men after adjusting for prognostically important baseline differences (hazard ratio [HR] 1.06, 95 % CI 0.97 to 1.17). However, after adjustment for baseline confounders and bleeding, female gender was associated with a lower risk of 1-year death. Thus, adjusted 1-year mortality was similar in women compared to men without bleeding (HR 1.08, 95 % CI 0.97 to 1.19) but lower in women compared to men with bleeding (HR 0.85, 95 % CI 0.73 to 0.98, p for interaction of gender by bleeding = 0.0016). The highest adjusted 1-year mortality was observed in men with bleeding (HR 2.42, 95 % CI 2.20 to 2.66) followed by women with bleeding (HR 2.05, 95 % CI 1.80 to 2.33) and women without bleeding (HR 1.08, 95 % CI 0.97 to 1.19, referent men without bleeding). In conclusion, in patients with fibrinolytic-treated STEMI, women had a higher incidence but lower mortality with bleeding than men. These data highlight the importance of understanding factors associated with gender-related differences in bleeding and represent an opportunity for improving outcomes of women and men with fibrinolytic-treated STEMI.