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Comparison of Clinical Outcomes for Women and Men after Acute Myocardial Infarction

Richard C. Becker, MD; Michael Terrin, MD; Richard Ross, MS; Genell L. Knatterud, PhD; Patrice Desvigne-Nickens, MD; Joel M. Gore, MD; Eugene Braunwald, MD, Thrombolysis in Myocardial Infarction Investigators*
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From the Thrombosis Research Center, University of Massachusetts Medical School, Worcester, Massachusetts; the TIMI Coordinating Center, Maryland Medical Research Institute, Baltimore, and the National Heart, Lung, and Blood Institute, Bethesda, Maryland; Brigham and Women's Hospital, Boston, Massachusetts. Requests for Reprints: Richard C. Becker, MD, Thrombosis Research Center, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. Grant Support: By research contracts from the National Heart, Lung, and Blood Institute and by grants HL35058 and HL38460 from the same organization.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(8):638-645. doi:10.7326/0003-4819-120-8-199404150-00003
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Objectives: To assess differences in morbidity and mortality between men and women with acute myocardial infarction treated with thrombolytic therapy and the relation of differences to baseline patient characteristics and clinical features.

Design: Secondary analysis of observational findings among women and men enrolled in a clinical trial.

Setting: Hospitals participating in the Thrombolysis in Myocardial Infarction Phase II trial.

Measurements: Recurrent infarctions and deaths were assessed.

Main Results: The 6-week mortality rate was greater for women than for men (9% compared with 4%; adjusted relative risk, 1.54; P = 0.01). Death or reinfarction occurred in 15.9% of women and 9.5% of men (adjusted relative risk, 1.33; P = 0.02). Among patients enrolled for treatment with 100 mg of recombinant tissue plasminogen activator and assigned to a conservative strategy of watchful waiting with appropriate backup, the 6-week incidence of death was 7.5% for women and 3.8% for men (P = 0.01). The 6-week incidences of death or reinfarction were 14.2% and 8.9% (P = 0.01) among women and men, respectively.

Conclusions: Among patients in the Thrombolysis in Myocardial Infarction Phase II Trial, who all were diagnosed with myocardial infarction and were eligible to receive thrombolytic therapy, women had higher rates of mortality and morbidity than did men. Older age at the time of myocardial infarction and a history of diabetes accounted for much but probably not all of this difference.

*A complete list of TIMI Investigators has been published previously (see Ref. 17).


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Figure 1.
One-year Kaplan-Meier mortality curves for women and men.

The solid line represents men; the broken line represents women.

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Figure 2.
One-year Kaplan-Meier event rates for reinfarction in women and men.

The solid line represents men; the broken line represents women.

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