Effects of gender and race on prognosis after myocardial infarction: adverse prognosis for women, particularly black women

Controversy has arisen concerning whether gender influences the prognosis after myocardial infarction. Although some studies have shown there to be no difference between the sexes, most have indicated a worse prognosis for women, attributing this to differences in baseline characteristics. It has been further suggested that black women have a particularly poor prognosis after infarction. To determine the contribution of gender and race to the course of infarction, 816 patients with confirmed myocardial infarction who were enrolled in the Multicenter Investigation of the Limitation of Infarct Size (MILIS) were analyzed. Of those patients, 226 were women and 590 were men, 142 were black and 674 were white. The cumulative mortality rate at 48 months was 36% for women versus 21% for men (p less than 0.001, mean follow-up 32 months). The cumulative mortality rate by race was 34% for blacks versus 24% for whites (p less than 0.005). Both women and blacks exhibited more baseline characteristics predictive of mortality than did their male or white counterparts. It was possible to account for the greater mortality rate of blacks by identifiable baseline variables; however, even after adjustment, the mortality rate for women remained significantly higher (p less than 0.002). The poorer prognosis for women was influenced by a particularly high mortality rate among black women (48%); the mortality rate for white women was 32%, for black men 23% and for white men 21%. The mortality for black women was significantly greater than that of the other subgroups. Thus, findings in the MILIS population indicate that the prognosis after myocardial infarction is worse for women, particularly black women.

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				V. Vaccarino, R. I. Horwitz, T. P. Meehan, M. K. Petrillo, M. J. Radford, and H. M. Krumholz Sex Differences in Mortality After Myocardial Infarction: Evidence for a Sex-Age Interaction Arch Intern Med, October 12, 1998; 158(18): 2054 - 2062. [Abstract] [Full Text] [PDF]

				N. C. Chandra, R. C. Ziegelstein, W. J. Rogers, A. J. Tiefenbrunn, J. M. Gore, W. J. French, M. Rubison, and for the National Registry of Myocardial Infarction Observations of the Treatment of Women in the United States With Myocardial Infarction: A Report From the National Registry of Myocardial Infarction-I Arch Intern Med, May 11, 1998; 158(9): 981 - 988. [Abstract] [Full Text] [PDF]

				H. V. Barron, L. J. Bowlby, T. Breen, W. J. Rogers, J. G. Canto, Y. Zhang, A. J. Tiefenbrunn, and W. D. Weaver Use of Reperfusion Therapy for Acute Myocardial Infarction in the United States : Data From the National Registry of Myocardial Infarction 2 Circulation, March 31, 1998; 97(12): 1150 - 1156. [Abstract] [Full Text] [PDF]

				L. Mosca, J. E. Manson, S. E. Sutherland, R. D. Langer, T. Manolio, E. Barrett-Connor, and E. Barrett-Connor Cardiovascular Disease in Women : A Statement for Healthcare Professionals From the American Heart Association Circulation, October 7, 1997; 96(7): 2468 - 2482. [Full Text]

				R. O. Cummins, D. Chamberlain, M. F. Hazinski, V. Nadkarni, W. Kloeck, E. Kramer, L. Becker, C. Robertson, R. Koster, A. Zaritsky, et al. Recommended Guidelines for Reviewing, Reporting, and Conducting Research on In-Hospital Resuscitation: The In-Hospital `Utstein Style' : A Statement for Healthcare Professionals From the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa Circulation, April 15, 1997; 95(8): 2213 - 2239. [Full Text]

				S Galatius-Jensen, J Launbjerg, L S. Mortensen, and J F. Hansen Sex related differences in short and long term prognosis after acute myocardial infarction: 10 year follow up of 3073 patients in database of first Danish verapamil infarction trial BMJ, July 20, 1996; 313(7050): 137 - 140. [Abstract] [Full Text]

				C. M. Albert, B. A. McGovern, J. B. Newell, and J. N. Ruskin Sex Differences in Cardiac Arrest Survivors Circulation, March 15, 1996; 93(6): 1170 - 1176. [Abstract] [Full Text]

				K.M.A. Hussain, L. Gould, B. Sosler, T. Bharathan, and C.V.R. Reddy Clinical Science Review: Current Aspects of Thrombolytic Therapy in Women with Acute Myocardial Infarction Angiology, January 1, 1996; 47(1): 23 - 33. [Abstract] [PDF]

				H. Bueno, M. T. Vidan, A. Almazan, J. L. Lopez-Sendon, and J. L. Delcan Influence of Sex on the Short-term Outcome of Elderly Patients With a First Acute Myocardial Infarction Circulation, September 1, 1995; 92(5): 1133 - 1140. [Abstract] [Full Text]

				D. Pratico and G. A. FitzGerald Testosterone and Thromboxane : Of Muscles, Mice, and Men Circulation, June 1, 1995; 91(11): 2694 - 2698. [Full Text]

				V. Vaccarino, H. M. Krumholz, L. F. Berkman, and R. I. Horwitz Sex Differences in Mortality After Myocardial Infarction : Is There Evidence for an Increased Risk for Women? Circulation, March 15, 1995; 91(6): 1861 - 1871. [Abstract] [Full Text]

				T. Brzostek, F. Van de Werf, I. Scheys, L. Mortelmans, A. Aubert, J. S. Dubiel, and H. De Geest Determinants of Left Ventricular Function Two Weeks and One Year After an Acute Myocardial Infarction Angiology, January 1, 1995; 46(1): 27 - 36. [Abstract] [PDF]

				K W Clarke, D Gray, N A Keating, and J R Hampton Do women with acute myocardial infarction receive the same treatment as men? BMJ, September 3, 1994; 309(6954): 563 - 566. [Abstract] [Full Text]

				N. K. Wenger, L. Speroff, and B. Packard Cardiovascular Health and Disease in Women N. Engl. J. Med., July 22, 1993; 329(4): 247 - 256. [Full Text]

				D. A. Leaf, M. E. Sanmarco, and R. A. Bahl Gender Differences in Coronary Angiographic Findings from 1972 Through 1981 in Los Angeles, California Angiology, August 1, 1990; 41(8): 609 - 615. [Abstract] [PDF]