Editor's Choice- Gender difference in prognostic impact of in-hospital bleeding after myocardial infarction - data from the SWEDEHEART registry.
BACKGROUND
Bleeding complications increase mortality in myocardial infarction patients. Potential gender difference in bleeding regarding prevalence and prognostic impact is still controversial.


OBJECTIVES
Gender comparison regarding incidence and prognostic impact of bleeding in patients hospitalised with myocardial infarction during 2006-2008.


METHODS
Observational study from the SWEDEHEART register. Outcomes were in-hospital bleedings, in-hospital mortality and one-year mortality in hospital survivors.


RESULTS
A total number of 50,399 myocardial infarction patients were included, 36.6% women. In-hospital bleedings were more common in women (1.9% vs. 3.1%, p<0.001) even after multivariable adjustment (odds ratio (OR) 1.17, 95% confidence interval (CI) 1.01-1.37). The increased risk for women was found in ST-elevation myocardial infarction (OR 1.46, 95% CI 1.10-1.94) and in those who underwent percutaneous coronary intervention (OR 1.80, 95% CI 1.45-2.24). In contrast the risk was lower in medically treated women (OR 0.79, 95% CI 0.62-1.00). After adjustment, in-hospital bleeding was associated with higher risk of one-year mortality in men (OR 1.35, 95% CI 1.04-1.74), whereas this was not the case in women (OR 0.97, 95% CI 0.72-1.31).


CONCLUSIONS
Female gender is an independent risk factor of in-hospital bleeding after myocardial infarction. A higher bleeding risk in women appeared to be restricted to invasively treated patients and ST-elevation myocardial infarction patients. Even though women have higher short- and long-term mortality, there was no difference between the genders among bleeders. After multivariable adjustment the prognostic impact of bleeding complications was higher in men.
['Holm|Anna|A|', 'Sederholm Lawesson|Sofia|S|', 'Swahn|Eva|E|', 'Alfredsson|Joakim|J|']
D000319:Adrenergic beta-Antagonists D000368:Aged D000806:Angiotensin-Converting Enzyme Inhibitors D005260:Female D006470:Hemorrhage D017052:Hospital Mortality D006760:Hospitalization D006801:Humans D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors D015994:Incidence D008297:Male D000072658:Non-ST Elevated Myocardial Infarction D010975:Platelet Aggregation Inhibitors D011379:Prognosis D000072657:ST Elevation Myocardial Infarction D017678:Sex Distribution D012737:Sex Factors D013548:Sweden D014859:Warfarin
gender bleeding Myocardial infarction prognosis