Gender Differences in Acute Myocardial Infarction in the Era of Reperfusion (The MITRA Registry) Tobias Heer, MD, Rudolf Schiele, MD, Steffen Schneider, PhD, Anselm K. Gitt, MD, Harm Wienbergen, MD, Martin Gottwik, MD, Ulf Gieseler, MD, Thomas Voigtla ¨nder, MD, Karl E. Hauptmann, MD, Stefan Wagner, MD, and Jochen Senges, MD, for the MITRA Study Group There is conflicting information about gender differences in presentation, treatment, and outcome after acute ST elevation myocardial infarction (STEMI) in the era of thrombolytic therapy and primary percutaneous coro- nary intervention. From June 1994 to January 1997, we enrolled 6,067 consecutive patients with STEMI admitted to 54 hospitals in southwest Germany in the Maximal Individual TheRapy of Acute myocardial infarction (MITRA), a community-based registry. Women were 9 years older than men, more often had hypertension, diabetes mellitus, and congestive heart failure, and had a history of previous myocardial infarction less often. Women had a longer prehospital delay (45 minutes), had anterior wall infarction more often (odds ratio [OR] 1.21; 95% confidence interval [CI] 1.08 to 1.36), and received reperfusion therapy less often (OR 0.83; 95% CI 0.74 to 0.94). The percentage of patients who were eligible for thrombolysis and received no reperfusion was higher in women (OR 1.7; 95% CI 1.56 to 1.89). Women had recurrent angina (OR 1.45; 95% CI 1.23 to 1.71) and congestive heart failure (OR 1.26; 95% CI 1.01 to 1.56) more often. There was a trend toward a higher hospital mortality in women (age-adjusted OR 1.16, 95% CI 0.99 to 1.35; multivariate OR 1.21, 95% CI 0.96 to 1.51), but there was no gender difference in long-term mortality after multivariate analysis (age-ad- justed OR 0.95, 95% CI 0.78 to 1.15; multivariate OR 0.93, 95% CI 0.72 to 1.19). Thus, women with STEMI receive reperfusion therapy less often than men. They experience recurrent angina and congestive heart fail- ure more often during their hospital stay. The age-ad- justed long-term mortality is not different between men and women, but there is a trend for a higher short-term mortality in women. 2002 by Excerpta Medica, Inc. (Am J Cardiol 2002;89:511–517) A considerable number of studies about gender differences in mortality after acute ST elevation myocardial infarction (STEMI) have consistently demonstrated that unadjusted mortality rates after STEMI are higher in women. This was shown espe- cially in short-term follow-up studies. 1–3 However, there are conflicting data about gender differences of mortality after adjusting for age and other risk factors. Some studies 3–5 found a similar outcome in men and women after such adjustment, whereas other studies failed to show the impact of age and other risk factors on higher mortality rates in women. 6–8 Only a few studies have examinened consecutive patients with STEMI after the introduction of routine thrombolytic therapy and primary percutaneous coronary interven- tion (PCI). The purpose of this study was to examine presentation, acute therapy, and short- and long-term mortality of men and women with confirmed STEMI consecutively admitted over an 18-month period from 1994 until 1997 in a defined region of Germany, with special respect to the interaction of age and gender. METHODS The MITRA registry: The Maximal Individual TheRapy of Acute myocardial infarction (MITRA) is a prospective German multicenter registry investigat- ing the current treatment of acute myocardial infarc- tion. The 54 participating hospitals are located in the Southwest of Germany. This region is representative of the rest of Germany. Almost all hospitals within a defined area participated, so that almost all patients with myocardial infarction within this area were reg- istered. The study centers included university hospi- tals, community hospitals, and tertiary care centers, all providing intensive care units and medical reperfusion therapy, some of them (n = 11) with facilities for From Herzzentrum Ludwigshafen, Kardiologie, Ludwigshafen; Klinikum Nu ¨rnberg, Nu ¨rnberg; Diakonissenkrankenhaus Speyer, Speyer; Jo- hannes Gutenberg Universita ¨t, Mainz; Krankenhaus der Barmherzigen Bru ¨der, Trier; and Fu ¨rst-Strium Klinik Bruchsal, Bruchsal, Germany. This study was supported in part by Astra-Zeneca GmbH, Plankstadt; Bristol Myers Squibb, Munich; Knoll AG, Ludwigshafen; and Landesver- sicherungsanstalt, Rheinland Pfalz, Germany. Manuscript received June 12, 2001; revised manuscript received and accepted October 17, 2001. Address for reprints: Tobias Heer, MD, Herzzentrum Ludwig- shafen, Department of Cardiology, Medizinische Klinik B, Bremser- strasse 79, D-67063 Ludwigshafen, Germany. E-mail: tobias.heer@ planet-interkom.de. 511 ©2002 by Excerpta Medica, Inc. All rights reserved. 0002-9149/02/$–see front matter The American Journal of Cardiology Vol. 89 March 1, 2002 PII S0002-9149(01)02289-5