Sex differences in acute myocardial infarction: Is it only the age?

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Abstract

Background

Several studies have shown that, after an acute myocardial infarction, women have worse prognosis than males. However, it is not clear if female sex is an independent predictor of mortality risk. Our aim was to analyse sex influence on the prognosis of these patients.

Methods

Retrospective registry of patients with ST segment elevation myocardial infarction (STEMI) from January 2010 to April 2015.

Results

From 1111 patients, 258 (23.2%) were women. Compared with men, they presented higher risk profiles with older age (70.1 ± 14.4 years vs. 62.3 ± 13.4, P < 0.001), more cardiovascular risk factors (except smoking), longer time from symptoms onset to hospital arrival (5.2 ± 4.1 h vs. 4.2 ± 3.7), higher Killip classification (1.6 ± 1.1 vs. 1.4 ± 0.8), fewer complete revascularizations (175 [67.8%] vs. 662 [77.9%] in men) and higher in-hospital mortality (26 [10.1%] vs. 34 [4.0%]); all p values < 0.003. At discharge, women less frequently received ACE inhibitors (189 [81.1%] vs. 702 [85.8%], p = 0.045) and presented more major adverse events (death, bleeding, infection, myocardial infarction, stent thrombosis or heart failure) during the first month after discharge (10.5% vs. 4.5%, p < 0.001) and higher long-term mortality (hazard ratio [HR] 1.6, 95% CI 1.1–2.2). After adjusting by age, most of the differences disappeared, and sex was not an independent factor of in-hospital (odds ratio 1.71, 95% CI 0.97–2.99) or long-term mortality (HR 1.0, 95% CI 0.7–1.5).

Conclusions

In patients with acute STEMI, the association of female sex with poor prognosis is mainly explained by age. Sex does not seem to be an independent prognostic factor.

Section snippets

Methods

Our data come from the DIAMANTE (Descripción del Infarto Agudo de Miocardio: Actuaciones, Novedades, Terapias y Evolución—Description of Acute Myocardial Infarction: Management, New Therapies and Evolution) database. This database includes prospectively collected consecutive patients with STEMI admitted to the Coronary Intensive Care Unit of the Gregorio Marañon General Hospital (Madrid, Spain), a primary PCI-capable tertiary centre offering service “24/7”, between January 2010 and April 2015.

Results

The registry included 1111 patients (258 women; 23.2%). Mean age was 64.1 ± 14.0 years. The proportion of women increased with age (from 14.7% in the first quartile [< 53 years] to 40.4% in those in the last one [> 76]). Nine patients were missing at 30 days of follow-up (0.8%), and long-term follow-up data could not be recorded in 22 patients (2.0%). Mean follow-up was 23.8 ± 19.4 months.

Baseline characteristics according to sex are shown in Table 1A, Table 1B. Mean age in women was 8 years higher than

Discussion

Our study confirms that in patients with STEMI, women have higher unadjusted in-hospital and long-term mortality than men. However, this difference is mainly due to age. In fact, the differences in mortality between men and women disappeared only by performing age adjustment.

In the first 30 days, major adverse events were more frequent in women than in men, but women presented more frequently with cardiovascular risk factors (except smoking) and a more severe clinical presentation; factors that

Funding support

This work was partially supported by the Red de Investigación Cardiovascular (RiC), Instituto de Salud Carlos III, Madrid, Spain, grant number RD120042/0001. The sponsor had no role in the study.

Conflict of interest

None. All authors have approved the final article.

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