Canadian Neighbor Pharmacy: Results of Gender Differences in the Management of Acute Inferior or Posterior Myocardial Infarction

hypertension Characteristics of the Patients

Female patients (n = 257) were significantly older and had a higher prevalence of diabetes and hypertension (Table 1). A longer delay from onset of symptoms to hospital admission was found in women (8 h vs 6 h). Women also presented with cardiogenic shock on hospital admission more frequently than men.

Reperfusion Therapy

Women were significantly less likely to receive fibrinolytic therapy than men (Table 2). This difference was explained, at least in part, by their older age and a longer time delay (adjusted odds ratio [OR] for reperfusion therapy, 0.84; 95% confidence interval [CI], 0.59 to 1.24) [Table 3].

Medication During Hospitalization

Medications used to prevent or treat heart failure (diuretics, inotropic agents, and angiotensin-converting enzyme inhibitors) were more frequently used in women (Table 4), whereas statins were prescribed less often. Aspirin, ^-blockers, and heparin were used similarly in both genders.

Noninvasive Studies

Noninvasive studies (97.6% exercise stress tests) were performed less frequently in women than in men, regardless of age (Table 2). This difference was particularly pronounced in patients a 75 years old (p value for sex-age interaction, 0.002). Among hospital survivors who were not treated by primary PCI, noninvasive tests were performed in 8% of women a 75 years old and in 33% of men a 75 years old (adjusted OR, 0.17; 95% CI, 0.08 to 0.36; p s 0.0005). You may read Latest publications on Canadian Neighbor Pharmacy facebook if you like to get to know more and more daily.

Coronary Angiography

Women had a lower chance than men to undergo coronary angiography during hospitalization. The gender difference persisted after adjustment for confounding variables (adjusted OR, 0.59; 95% CI, 0.37 to 0.93; p = 0.02) [Table 3]. Age had an important effect on the relation between gender and the use of coronary angiography (p value for sex/age interaction, 0.002). While women < 75 years old were referred for coronary angiography as frequently as men (adjusted OR, 0.93; 95% CI, 0.62 to 1.31; p = 0.7), it was performed less frequently in older women (adjusted OR, 0.41; 95% CI, 0.23 to 0.72, p = 0.002).

In-hospital Mortality

The crude in-hospital mortality rate was 26% for women and 9% for men (p < 0.0005) [Table 2]. The higher mortality of women was observed in younger and older patients. However, after adjustment for clinical dissimilarities, we only found a nonsignificant trend toward a higher in-hospital death rate in women (Table 3).

Table 1—Demographic and Clinical Characteristics of Patients Admitted With Acute Inferior MI, According to Sex

Characteristics Women (n = 257) Men (n = 921) p Value
Age, yr 73(66-81) 62 (53-70) < 0.0001
Age a 75 yr 127 (49) 135 (15) < 0.0001
Delay on arrival, h 4(2-12) 3(2-6) 0.005
Risk factors
Hypertension 157 (61.1) 304 (33.1) < 0.0001
Left ventricular hypertrophy 72 (28.2) 133 (14.4) 0.004
Diabetes 99 (38.5) 179 (19.4) < 0.0001
Current smoking 40 (15.6) 667 (72.4) < 0.0001
Hyperlipemia 86 (33.5) 364 (39.5) 0.08
Previous diseases
Stroke 25 (9.7) 43 (4.7) 0.02
Previous MI 25 (9.7) 116(12.6) 0.2
COPD 17 (6.8) 134 (14.5) < 0.0001
In hospital
Systolic BP on hospital admission 129(110-150) 127(110-140) 0.51
Diastolic BP on hospital admission 76 (69-90) 77 (70-90) 0.77
Heart rate on hospital admission 77 (62-90) 74 (60-85) 0.05
Peak CK-MB values 225 (91-278) 223(105-298) 0.93
ST-segment depression > 1 mm in V4-V6 75 (29.2) 345 (37.5) 0.01
Right ventricular infarction 111 (43.1) 362 (39.3) 0.23

Table 2—In-Hospital Stay, Adverse E-vents, and Interventions in Patients With Acute Inferior MI, According to Gender

Variables Women (n = 257) Men (n = 921) pValue
In-hospital outcomes
Adverse in-hospital events 156 (60.8) 370 (40.2) < 0.0005
Congestive heart failure 81 (31.4) 80 (8.7) < 0.0005
Cardiogenic shock 45 (17.6) 58 (6.3) < 0.0005
Reinfarction 19 (7.5) 50 (5.4) 0.2
Mechanical complications 24 (9.5) 36 (3.9) 0.005
Complete AV block 50 (19.6) 111 (12.1) 0.003
Primary ventricular 13(5.1) 64 (7.0) 0.29
fibrillation
Length of stay, d 13.8 ± 12.5 14.1 ± 9.9 0.78
In-hospital mortality 68 (26.5) 82 (8.8) < 0.0005
< 75 yr 20 (15.4) 54 (6.9) 0.001
a 75 yr 48 (37.8) 27 (20.0) 0.001
Interventions
Reperfusion therapy 116(45.1) 558 (60.6) < 0.0005
Age < 75 yr 70 (53.8) 499 (63.5) 0.36
Age a 75 yr 46 (36.2) 59 (43.7) 0.21
Delay s 6 h 104 (65.4) 517 (74.2) 0.04
Delay 6 to 12 h 5 (10.9) 20 (18.5) 0.18
Delay 12 to 24 h 5 (12.8) 15 (17.9) 0.49
Fibrinolytic therapy 84 (32.6) 425 (46.1) < 0.0005
Primary PCI 32 (12.5) 134 (14.5) 0.42
Noninvasive studies 69 (42.3) 530 (73.9) < 0.0005
Age < 75 yr 60 (64.5) 491 (78.1) 0.004
Age a 75 yr 9(12.9) 39 (44.3) < 0.0005
Coronary angiography 41 (25.0) 289 (40.3) < 0.0005
Age < 75 yr 36 (38.7) 265 (42.1) 0.53
Age a 75 yr 5 (7.0) 24 (27.0) 0.001
PCI 36(14.1) 216 (23.4) 0.001
Coronary artery bypass graft 8 (3.2) 41 (4.4) 0.4

Table 3—Influence of Female Gender on the Use of Reperfusion Therapy, Coronary Angiography, Noninvasive Studies, and In-Hospital Mortality

Interventions Adjusted OR (95% CI)T p Value
Reperfusion therapy 0.84 (0.59-1.24) NS
Sex/age interaction for reperfusion therapy NS
Coronary angiography 0.59 (0.37-0.93) 0.02
Sex/age interaction for diagnostic catheterization 0.94 (0.9-0.98) 0.002
Noninvasive studies 0.17 (0.08-0.36) < 0.005
Sex/age interaction for noninvasive studies 0.94 (0.9-0.98) 0.002
In-hospital mortality 1.40 (0.94-2.31) 0.07
Sex/age interaction for in-hospital mortality NS

Table 4—Use of Pharmacologic Therapies During Hospitalization According to Sex

Women Men p
Variables (n = 257) (n = 921) Value
Aspirin 238 (92.7) 872 (94.7) 0.27
P-Blockers 86 (33.3) 344 (37.3) 0.29
Calcium antagonists 79 (30.9) 277 (30.1) 0.85
Ticlopidine 44 (17.2) 197 (21.4) 0.19
Statins 25 (9.8) 144 (15.6) 0.02
Heparin 176 (68.5) 677 (73.5) 0.26
Nitrates 179 (69.9) 629 (68.3) 0.72
Diuretics 68 (26.5) 124 (13.5) < 0.0005
Inotropic agents 59 (23.0) 119(12.9) < 0.0001
Angiotensin-converting enzyme 104 (40.5) 262 (28.4) 0.002
inhibitors