Editor’s Choice- Gender difference in prognostic impact of in-hospital bleeding after myocardial infarction – data from the SWEDEHEART registry

Abstract

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.