The online version of this article (doi:10.1186/s12872-017-0508-3) contains supplementary material, which is available to authorized users.
Gender differences in short-term mortality in acute myocardial infarction (AMI) have been studied extensively, whereas gender differences in long-term mortality and cause of death largely remain unknown. The aim of this study was to assess the long-term risk of all-cause, cardiovascular and cancer death after AMI in women compared to men.
Consecutive AMI patients were enrolled in a prospective registry between 2005 and 2011. Date and cause of death were obtained by linkage with the Norwegian Cause of Death Registry, with censoring date 31 December 2012. AMI patients with ST-segment elevation (STEMI, n = 5159) and without (NSTEMI, n = 4899) were analysed separately.
The 5-years all-cause mortality rates in STEMI were 29% in women vs. 17% in men, and 42% vs. 29% in NSTEMI, respectively. After adjustment for age and other confounders, women with STEMI had similar (HR 1.13 [95% CI: 0.98–1.32]) and women with NSTEMI lower (HR 0.82 [95% CI: 0.73–0.92]) risk of long-term all-cause mortality compared to men. Competing-risks analysis showed no significant gender differences in age-adjusted risk of cardiovascular death nor of cancer death. In both genders, the annual risk of cardiovascular death was low after 1 year, but exceeded annual risk of cancer death throughout follow-up.
During long-term follow-up, women with STEMI had similar and women with NSTEMI lower adjusted risk of all-cause mortality compared to men. Age-adjusted risk of death due to cardiovascular disease was similar in both genders and higher than risk of death due to cancer throughout the follow-up period.
Additional file 1: Appendix Table A1. Medications in-hospital for women and men with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). (DOCX 20 kb)12872_2017_508_MOESM1_ESM.docx
Additional file 2: Appendix Table A2. Complications in-hospital for women and men with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). (DOCX 21 kb)12872_2017_508_MOESM2_ESM.docx
Simon T, Mary-Krause M, Cambou JP, Hanania G, Gueret P, Lablanche JM, et al. Impact of age and gender on in-hospital and late mortality after acute myocardial infarction: increased early risk in younger women: results from the French nation-wide USIC registries. Eur Heart J. 2006;27:1282–88. CrossRefPubMed
Otten AM, Maas AH, Ottervanger JP, Kloosterman A, Hof AW v’t, Dambrink JH, et al. Is the difference in outcome between men and women treated by primary percutaneous coronary intervention age dependent? Gender difference in STEMI stratified on age. Eur Heart J Acute Cardiovasc Care. 2013;2:334–41. CrossRefPubMedPubMedCentral
Hess CN, McCoy LA, Duggirala HJ, Tavris DR, O’Callaghan K, Douglas PS, Peterson ED, Wang TY. Sex-based differences in outcomes after percutaneous coronary intervention for acute myocardial infarction: a report from TRANSLATE-ACS. J Am Heart Assoc. 2014;3:e000523. doi: 10.1161/JAHA.113.000523. CrossRefPubMedPubMedCentral
Blomkalns AL, Chen AY, Hochman JS, Peterson ED, Trynosky K, Diercks DB, et al. Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative. J Am Coll Cardiol. 2005;45:832–37. CrossRefPubMed
Competing risks. In: Cleves M, GouldW, Guiterrez RG, Marchenko YV: An introduction to survival analysis using STATA. 3rd ed. Stata press. 2010; pp.365-91.
Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509. CrossRef
German R. Cumulative incidence. 2012. http://data.princeton.edu/pop509/cumulativeIncidence.pdf. Accessed 9 Mar 2017.
STROBE Initiative. STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Checklist. ISPM University of Bern. 2007. http://strobe-statement.org/index.php?id=available-checklists. Accessed 9 Mar 2017.
Alfredsson J, Lindback J, Wallentin L, Swahn E. Similar outcome with an invasive strategy in men and women with non-ST-elevation acute coronary syndromes: from the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). Eur Heart J. 2011;32:3128–36. CrossRefPubMed
Norwegian Institute of Public Health. Cancer mortality in Norway - fact sheet 2009. 2015 http://www.fhi.no/en/mp/chronic-diseases/cancer/cancer-mortality-in-norway---fact-s/. Accessed 9 Mar 2017.
- Gender differences in all-cause, cardiovascular and cancer mortality during long-term follow-up after acute myocardial infarction; a prospective cohort study
Kristin Marie Kvakkestad
Morten Wang Fagerland
- BioMed Central
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