Prognosis in myocardial infarction in relation to gender

doi:10.1016/0002-8703(94)90620-3

American Heart Journal

Volume 128, Issue 3, September 1994, Pages 477-483

https://doi.org/10.1016/0002-8703(94)90620-3 Get rights and content

Abstract

We studied 921 consecutive patients admitted to a single hospital for acute myocardial infarction during a period of 21 months and related their prognosis to gender. Women (n = 300, 33%) were on average 7 years older (p < 0.001) and more frequently had a previous history of hypertension (p < 0.001) and congestive heart failure (p < 0.001) than did men. They also tended to delay longer in seeking medical treatment and more often presented with only vague symptoms (p < 0.05). The in-hospital mortality for women was 19% versus 12% for men (p < 0.01). Women more often showed signs of congestive heart failure (p < 0.05) despite smaller infarcts as estimated from enzyme levels (p < 0.05). Total mortality during 1 year was 36% in women and 25% in men (p < 0.01). In a multivariate analysis, female gender did not appear as an independent risk factor for death. During 1 year of follow-up no differences in morbidity were observed between the sexes. We conclude that if women fare worse than men after suffering an acute myocardial infarction, the increased mortality is accounted for by older age.

References (28)

DJ Lerner et al.
Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population
Am Heart J
(1986)
WB Kannel et al.
Natural history of angina pectoris in the Framingham study: prognosis and survival?
Am J Cardiol
(1972)
L Lapidus et al.
Prognosis for women with different symptoms and signs suggesting ischemic heart disease: a 12-year follow-up
J Chron Dis
(1985)
H Dittrich et al.
Acute myocardial infarction in women: influence of gender on mortality and prognostic variables
Am J Cardiol
(1988)
K Robinson et al.
Risk factors and in-hospital course of first episode of myocardial infarction or acute coronary insufficiency in women
J Am Coll Cardiol
(1988)
WB Kannel et al.
Prognosis after initial myocardial infarction: the Framingham Study
Am J Cardiol
(1979)
GH Tofler et al.
Effects of gender and race on prognosis after myocardial infarction: adverse prognosis for women, particularly black women
J Am Coll Cardiol
(1987)
WB Kannel et al.
Incidence and prognosis of unrecognized myocardial infarction: an update on the Framingham Study
N Engl J Med
(1984)
SB Schmidt et al.
The prehospital phase of acute myocardial infarction in the era of thrombolysis
Am J Cardiol
(1990)
BW Karlson et al.
Clinical factors associated with delay time in suspected acute myocardial infarction
Am Heart J
(1990)

G Boethius

Recording of drug prescriptions in the county of Jämtland, Sweden

Acta Med Scand

(1977)

C Maynard et al.

Gender differences in the treatment and outcome of acute myocardial infarction

Arch Intern Med

(1992)

NK Wenger

Coronary disease in women

Annu Rev Med

(1985)

NH Fiebach et al.

Differences between women and men in survival after myocardial infarction: biology or methodology?

JAMA

(1990)

Cited by (93)

Advanced Therapies for Advanced Heart Failure in Women
2019, Heart Failure Clinics
Controversies in the Treatment of Women with ST-Segment Elevation Myocardial Infarction
2016, Interventional Cardiology Clinics
Citation Excerpt :
In addition, ischemia is more often silent,21,22 and MI is frequently unrecognized in women compared with men.23,24 Because of these differences in symptoms, women may not recognize that their complaints are cardiac in origin and are more likely to present later after symptom onset than men.18,25–34 Thus, physicians must be attuned to these differences in symptoms to expedite care once women do present to a medical care setting.
Age-related macular degeneration and risk of total and cause-specific mortality over 15 years
2016, Maturitas
We aimed to investigate the independent association between AMD and risk of ischemic heart disease (IHD), stroke, and cardiovascular (CVD) mortality, and all-cause mortality over 15 years.
3654 participants aged 49+ years at baseline were followed over 15 years. AMD was assessed from retinal photographs. Deaths and cause of death were confirmed by data linkage with the Australian National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) were assessed using Cox models.
71.4% (n = 162) and 34.6% (n = 1037) of participants with any AMD and no AMD, respectively, died over 15 years. After multivariable-adjustment, no significant associations were observed between AMD and total- and cause-specific mortality in the overall cohort. However, among men, late AMD at baseline was associated with an increased risk of all-cause mortality (n = 22; 95.7%), 15 years later: multivariable-adjusted HR, 1.80 (95% CI 1.04–3.11). Women with late AMD had 2-fold increased risk of stroke mortality (n = 15; 28.9%), HR 2.10 (95% CI 1.08–4.06). Early-stage AMD was not associated with mortality risk.
Late AMD independently predicted all-cause mortality in men and stroke mortality in women, over 15 years. Although underlying mechanisms are unclear, these findings indicate that late AMD is a marker of biological aging.
Interventions for ST Elevation Myocardial Infarction in Women
2012, Interventional Cardiology Clinics
Gender differences of success rate of percutaneous coronary intervention and short term cardiac events in Korea Acute Myocardial Infarction Registry
2008, International Journal of Cardiology
The first on-line prospective, open and observational registration, Korea Acute Myocardial Infarction Registry (KAMIR), has been carried out throughout 41 primary percutaneous coronary intervention (PCI) centers by the support of the Korean Circulation Society (KCS) in the memorandum of the 50th Anniversary of the KCS.
Between Nov 2005 and Aug 2006, 5624 enrolled patients (3925 male, 1699 female; age = 64.0 ± 13.0 years) were analyzed. The treatment strategy of acute myocardial infarction (AMI) was analyzed according to the sex differences in the field of acute ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI).
In the initial selection of treatment strategy, invasive treatment was more commonly performed in males than females with both STEMI and NSTEMI (82.0% vs. 78.7%, p = 0.001; 50.4% vs. 43.7%, p = 0.004). Severe heart failure was the most important predictor of invasive treatment after multivariate adjustment. During hospital stay, PCI regardless of its subtype was more frequently performed in males than in females with both STEMI and NSTEMI (STEMI: 89.5% vs. 84.7%, p < 0.001; NSTEMI: 77.0% vs. 66.7%, p < 0.001). Success rate of PCI in STEMI was not different between the sexes (95.8% vs. 93.8%, p = 0.075), but that of NSTEMI was higher in males than females (96.8% vs. 95.6%, p = 0.005). Major adverse cardiac events (MACE) developed more frequently in women than men with both STEMI (9.2% vs. 17.0%, p < 0.001) and NSTEMI (7.3% vs. 12.0%, p < 0.001) during 1 month clinical follow-up.
In the initial treatment of AMI in Korea, there is no gender difference for invasive treatment. However, success rate of PCI in NSTEMI was lower and 1 month MACE was higher in females than males in Korea.
Predictors of depressive symptoms post-acute coronary syndrome
2007, Gender Medicine
Objective: We examined the influence of gender on the prevalence of acute coronary syndrome (ACS) and the severity of depressive symptoms post-ACS.
Methods: Patients received a Zung self-assessment questionnaire at hospital discharge for unstable angina (UA) or acute myocardial infarction (AMI) and returned it by mail. Major depressive symptoms were diagnosed based on a summed depressive symptoms (SDS) score of >50. Depressive symptomatology was modeled by stepwise multivariable logistic regression with the following predictors: gender, age, hypertension, diabetes mellitus, history of smoking, hypercholesterolemia, peripheral vascular disease, prior stroke, prior myocardial infarction (MI), and prior percutaneous coronary intervention or coronary artery bypass graft surgery. We also modeled severity of depressive symptoms via stepwise multiple linear regression with the same predictor variables.
Results: A total of 944 patients were surveyed: 716 men and 228 women, mean (SD) age, 67 (13) years and 71 (12) years, respectively. Of these patients, 250 (35%) men and 103 (45%) women had depressive symptoms (P = 0.005). No significant difference was observed between men and women in rates of cardiac catheterization; severity of coronary artery disease; treatment with antiplatelet agents, β-blockers, angiotensin-converting enzyme inhibitors, or statins; or percutaneous or surgical revascularization rates during or post-ACS. Significant predictors of the presence of depressive symptoms were female gender (odds ratio [OR] = 1.64; 95% CI, 1.19-1.28), diabetes mellitus (OR = 1.42; 95% CI, 1.03-1.97), prior MI (OR = 1.56; 95% CI, 1.15-2.20), and smoking (OR = 1.41; 95% CI, 1.01-1.97). Variables significantly associated with a higher severity of depressive symptoms were female gender, prior MI, smoking, and stroke. Men with prior MI had significantly higher mean (SD) SDS scores than did men without prior MI in all age groups (48.4 [11] vs 44.6 [11], respectively; P < 0.001). In addition, significantly more men with prior MI had depressive symptoms compared with those without prior MI (45% vs 32%; P = 0.001). However, prior MI did not appear to affect SDS scores in women (49.1 [12] for prior MI vs 48.5 [12] for no prior MI; P = NS), and there was no significant difference in the percentage of women who had depressive symptoms with or without a history of prior MI. Depressive symptoms were much more severe in women with UA (SDS = 49.0 [12]) compared with women with AMI (SDS = 45.0 [12]; P = NS), or men with AMI (45.0 [12]; P = 0.004) or UA (46.0 [11]; P = 0.007) (analysis of variance, P = 0.003).
Conclusions: Female gender is a significant independent predictor of depressive symptoms and their severity post-UA and post-AMI. History of prior MI is associated with a higher frequency and severity of depressive symptoms in men. These findings call for routine screening for depressive symptoms in men with prior MI and in women who present with ACS.

View all citing articles on Scopus

^☆: Supported by grants from The Swedish Heart Foundation, The Gothenburg Society of Medicine, and The Medical Faculty of the University of Gothenburg.

View full text

Prognosis in myocardial infarction in relation to gender☆

Abstract

Am Heart J

Am J Cardiol

J Chron Dis

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

N Engl J Med

Am J Cardiol

Am Heart J

Acta Med Scand

Arch Intern Med

Coronary disease in women

Annu Rev Med

Differences between women and men in survival after myocardial infarction: biology or methodology?

JAMA