Abstract 1512: Gender Disparities In Medical Treatment Contribute To The Excess In-hospital Mortality Rates In Romanian Women.
Objective. To investigate gender differences in clinical characteristics, treatment and case fatality rates in an unselected population of patients (pts.) admitted for ST-elevation myocardial infarction (STEMI) in Romania.
Methods: A group of 4624 consecutive STEMI pts. have been hospitalized from January 1st, 2000 to December 31st, 2005, and enrolled in the Romanian Registry for ST-segment elevation myocardial infarction (RO-STEMI). Patients were enrolled in 15 university and county hospitals; only 4 had cardiac catheterization facilities. Data have been collected prospectively in all pts.
Results: RO-STEMI enrolled 1368 women and 3252 men. Women were older (67 ± 11 vs 59 ± 12 years, p<0.0001), and had higher rates of hypertension (64.9% vs 49.1%, p<0.001), diabetes mellitus (22.8% vs 19.1%, p=0.004), and congestive heart failure on hospital admission (20.2% vs 12.9%, p<0.001). Women were less likely to be smoker (31.4% vs 61.6%, p<0.001) and to have a history of prior myocardial infarction (10.5 vs 12.7, p=0.03). Fewer women than men presented within 6 hours after symptom onset (60.8% vs 69.7%, p<0.001). A significantly lower proportion of women was treated with thrombolytics (55.1% vs 69%, p< 0.001), statins (51.3% vs 59.9, p<0.001), beta-blockers (61.4 vs 70.8, p<0.001), and percutaneous coronary interventions (4% vs. 7.25, p<0.001). The lower proportion of the use of thrombolytics and beta-blockers in women could be explained in part by the significant higher age of the women group. Women suffered an increased rate of cardiovascular death (20.4% vs 10.5%; OR, reference men: 2.1; 95% CI 1.8–2.5, p<0.001). After adjustment for any confounders the OR decreased to 1.36; 95% CI 1.07–1.72, p = 0.01. On multivariate analysis age and lack of evidence-based treatment were significant (p<0.05) predictors of case fatality in both genders.
Conclusions: Several factors contribute to the excess in-hospital case fatality rates in Romanian women. Most notably disparities in medical treatment, in part due to higher age, appear to play a crucial role.