Sex Differences in AMI Survival Over Time

Study Questions:

Has age- and sex-specific survival after acute myocardial infarction (AMI) and coronary heart disease (CHD) death changed over the past several decades?

Methods:

Data from an observational study in Sweden, which included 28-day and 1-year mortality, were used for the present analysis. Men and women, ages 35-84 years with first-time CHD events between 1987 and 2010, were included. Data from the national Swedish death index and hospital registries were used.

Results:

A total of 658,110 adults (234,651 [35.7%] women) were included in the present analysis. The cohort included 470,420 patients admitted to the hospital with a first AMI, and 187,690 patients had a fatal CHD event outside the hospital without prior AMI. The mean age was 68.3 years for men and 72.7 years for women in the hospital, and 71.9 years versus 75.9 years for men and women out of the hospital. Women had more diabetes, hypertension, stroke, heart failure, chronic respiratory disease, and malignancy, whereas men had more CHD. Age-adjusted 28-day case fatality decreased from 23.5% to 8.5% between 1987 and 2010 (p < 0.05). Among women ages 35-54 years, short-term survival was worse than men of the same age group and did not appear to improve substantially over time (hazard ratios [HRs] for women relative to men, 1.63; 95% confidence interval [CI], 1.28-2.08 at ages 35–54 years, and HR, 1.28; 95% CI, 1.12-1.46 at ages 55–64 years in 2005–2010), but after adjustment for comorbidities, differences between men and women were no longer significant (HR, 1.25; 95% CI, 0.97-1.61, and HR, 1.05; 95% CI, 0.91-1.20). When CHD deaths outside the hospital were included, women had better prognosis regardless of age and period. In patients surviving the first 28 days, age-adjusted 1-year case fatality decreased from 15.3% to 7.7% (p < 0.05) for both men and women. After adjustment for comorbidities, no significant sex differences persisted below the age of 75 years in the last period. For older women (75-84 years), females had a consistently better prognosis at 28 days compared with older men.

Conclusions:

The authors concluded that the worst short-term outcomes in women <55 years of age hospitalized with AMI did not persist after adjustment for comorbidities. When CHD deaths outside the hospital were included, women had a consistently better short-term prognosis. In 28-day survivors, women did not fare worse than men when differences in comorbidities were considered.

Perspective:

These data suggest that women presenting with AMI have significant comorbidities. Effective management of these conditions is likely to improve overall survival rates for both women and men.

Clinical Topics: Acute Coronary Syndromes, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Hypertension

Keywords: Acute Coronary Syndrome, Comorbidity, Coronary Artery Disease, Diabetes Mellitus, Geriatrics, Heart Failure, Hypertension, Myocardial Infarction, Neoplasms, Primary Prevention, Prognosis, Sex Characteristics, Stroke, Survival Rate, Women


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