LETTER
Sex-related Outcome Differences after Acute Myocardial Infarction
George A. Mensah;
Richard S. Cooper; and
Youlian Liao
15 November 1994 | Volume 121 Issue 10 | Pages 815-816
TO THE EDITOR:
We were intrigued by the study of Becker and colleagues [1], who showed higher morbidity and mortality rates in women than in men after acute myocardial infarction treated with thrombolytic agents. Older age at the time of myocardial infarction and higher prevalence of diabetes mellitus, hypertension, and previous heart failure in women did not completely explain the observed sex difference in clinical outcomes. These clinical characteristics suggest that left ventricular hypertrophy might be more prevalent in women and may partially explain the differences.
Recent data have established left ventricular hypertrophy as a powerful independent predictor of cardiovascular complication and death from all causes in patients with and without coronary artery disease [2]. Data from canine models of acute myocardial infarction show that left ventricular hypertrophy, especially in dogs with hypertension, leads to a more rapid progression of myocardial necrosis [3], larger infarction size [4], and as much as a fourfold increase in mortality. Bolognese and associates [5] recently showed that in uncomplicated, acute myocardial infarction associated with single-vessel coronary artery disease, the left ventricular mass index is the only independent predictor of cardiac events. Previous studies that showed adverse clinical outcomes in women who received thrombolytic therapy for acute myocardial infarction, however, did not evaluate baseline differences in left ventricular mass. We wonder whether differences in the prevalence of left ventricular hypertrophy (using sex-specific criteria) might explain most the observed sex difference in clinical outcomes.
1. Becker RC, Terrin M, Ross R, Knatterud GL, Desvigne-Nickens P, Gore JM, et al. Comparison of clinical outcomes for women and men after acute myocardial infarction. Ann Intern Med. 1994; 120:638-45.
2. Ghali JK, Liao Y, Simmons B, Castaner A, Cao G, Cooper RS. The prognostic role of left ventricular hypertrophy in patients with or without coronary artery disease. Ann Intern Med. 1992; 117:831-6.
3. Dellsperger KC, Clothier JL, Hartnett JA, Haun LM, Marcus ML. Acceleration of the wavefront of myocardial necrosis by chronic hypertension and left ventricular hypertrophy in dogs. Circ Res. 1988; 63:87-96.
4. Koyanagi S, Eastham CL, Harrison DG, Marcus ML. Increased size of myocardial infarction in dogs with chronic hypertension and left ventricular hypertrophy. Circ Res. 1982; 50:55-62.
5. Bolognese L, Dellavesa P, Rossi L, Sarasso G, Bongo AS, Scianaro MC. Prognostic value of left ventricular mass in uncomplicated acute myocardial infarction and one-vessel coronary artery disease. Am J Cardiol. 1994; 73:1-5.
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