Women more likely to die or hemorrhage with post-MI fibrinolytic treatment

Among myocardial infarction (MI) patients who receive fibrinolytic drugs, female sex is independently associated with an increased risk of death and bleeding complications, researchers report in the Oct. 22 issue of the Archives of Internal Medicine.

Harmony R. Reynolds, MD, of the New York University School of Medicine, and colleagues analyzed data from the GUSTO V study in which 16,588 patients in 20 countries were randomly assigned to receive either standard-dose reteplase or standard-dose abciximab plus half-dose reteplase.

After 30 days, the researchers found that women were significantly more likely than men to die (9.8% vs. 4.4%) or experience bleeding (6.4% vs. 2.5%). They also found that women had a higher risk of complications such as reinfarction, stroke, and mechanical complications, and were less likely to receive angiography and percutaneous coronary intervention after fibrinolysis.

"Now that the nature of sex differences in the presentation, outcome, and management of acute myocardial infarction has been well established, further investigation is needed to improve our basic understanding of these differences," the authors conclude. "The key to improving outcomes in women with coronary artery disease may lie not only in ensuring that their treatment is equal to that of men but also in developing diagnostic and therapeutic approaches specific to sex." (This research was funded by Centocor and Eli Lilly.)

Reynolds HR, Farkouh ME, Lincoff AM, et al. Impact of female sex on death and bleeding after fibrinolytic treatment of myocardial infarction in GUSTO V. Arch Intern Med. 2007;167:2054-2060.