Abstract 2284: Explaining Women’s Worse Prognosis After Acute Myocardial Infarction
Women’s prognosis after acute myocardial infarction (AMI) is worse than men’s for reasons that are not yet clear. Anxiety level predicts post-AMI complications and is higher in women after AMI.
Purpose: To determine if there is an interaction between gender and anxiety in the prediction of in-hospital complications in an international sample of AMI patients.
Methods: A total of 1045 patients (mean age: 61 ±12 yrs; 28% women) with confirmed AMI from six countries (Thailand, South Korea, Japan, Australia, United Kingdom and the United States) were recruited for this study. Anxiety was measured using the anxiety subscale of the Brief Symptom Inventory within 48 hours of hospital admission. Sociodemographic and clinical data were collected by chart review and patient interview. In-hospital complications were defined as the occurrence of any of the following: reinfarction, recurrent ischemia, malignant dysrhythmias, cardiogenic shock, and acute heart failure. Reviewers blinded to patients’ anxiety level collected these data via extensive chart review. Multiple logistic regression was used to test the following model to predict the presence of any in-hospital complications: age, gender, anxiety level, beta-blocker administration, anxiolytic administration, fibrinolytic use, smoking status, hypertension, diabetes, admission Killip classification, previous AMI, previous angina, and marital status.
Results: Women had higher rates of in-hospital complications (30.4% of women vs. 22% of men, p = 0.008). In the multivariate model, the following variables significantly predicted complications: the interaction of anxiety and gender (odds ratio = 1.33, 95% confidence intervals [CI] 1.01 - 1.74, p = .04); anxiety (odds ratio = 1.23, 95% CI 1.04 - 1.47, p = .019); current smoker (odds ratio = 1.61, 95% intervals CI 1.15 - 2.24, p = .005); anxiolytic administration (odds ratio = 0.492, 95% CI 0.35 - 0.68, p = .001); Killip classification I (odds ratio = 0.50, 95% CI 0.36 - 0.70 p = .001); and fibrinolytic use (odds ratio = 0.70, 95% CI 0.50 - 0.97 p = .03).
Conclusions: Women’s higher rates of complications after AMI are partially the result of higher levels of anxiety but administration of anxiolytics significantly decreased complications in both men and women.