A sex difference in short-term survival after initial acute myocardial infarction. The MONICA-Bremen Acute Myocardial Infarction Register, 1985-1990

Abstract

Aims: To assess the difference between men and women as regards fatality shortly after acute myocardial infarction, and the relationship of patient characteristics.

Methods and results: One thousand seven hundred and ten male and 563 female patients, 25-69 years of age and hospitalized with a first acute myocardial infarction occurring from 1985 to 1990, were included in the population-based World Health Organization MONICA-Bremen Acute Myocardial Infarction Register. Patient information, including short-term survival status, was obtained from the medical records of the seven Bremen hospitals with internal medicine departments and municipal death certificate files. The unadjusted 28-day fatality rate after acute myocardial infarction was higher among women than among men (23.1% vs 16.1% respectively: P < 0.001). Adjusting for the older age of women did not eliminate the difference completely (females; 20.9%, males: 16.8%; P = 0.041). Controlling for previous use of inotropic medicine and diuretics, during-the-event receipt of thrombolysis and platelet inhibitors, and age in logistic regression analyses resulted in a similar 28-day mortality risk after acute myocardial infarction for both sexes (female/male odds ratio = 1.13, 95% confidence interval = 0.86 1.50; P = 0.389).

Conclusions: Sex was not an independent predictor of early acute myocardial infarction fatality. Our data suggest that the excess mortality risk in women can be explained by sex differences in age, pre-infarction cardiac impairment, and treatment during the coronary event.