INFLUENCE OF GENDER ON SHORT-TERM AND LONG-TERM MORTALITY AFTER ACUTEMYOCARDIAL-INFARCTION

The aim of this study wets to assess differences in short-and long-ter m mortality between male and female patients with acute myocardial inf arction (AMI). The study population consisted of 6,676 consecutive pat ients admitted alive with an enzyme-confirmed AMI to 27 Danish hospita ls from 1990 to 1992. Five patients were excluded because of missing i nformation. Female patients (n = 2,170) were on average 5 years older than male patients (n = 4,501, p <0.001), had lower body mass index, a nd more often had diabetes, hypertension, and congestive heart failure . Left ventricular systolic function was the same for men and women. W omen received thrombolytic therapy less often. The 1-year mortality fo r female patients was 28 +/- 1% and far men 21 +/- 1% (p < 0.001). The unadjusted risk ratio associated with male gender in a proportional-h azards model was 0.76 (95% confidence intervals [CI] 0.70 to 0.83). Ad justment for age removed the importance of gender, and the risk ratio associated with male gender was 1.06 (95% CI 0.97 to 1.2, p = 0.2). An introduction of further variables in the model did not change this. S ubdividing mortality into 6-day, 30-day, and late mortality demonstrat ed a significantly increased mortality in women in the short-term (6 a nd 30 days), with a risk ratio in men of 0.58 (95% CI 0.42 to 0.81) an d 0.80 (95% Cl 0.65 to 0.99), respectively. From day 30 onward there w as an increased mortality in men with ct risk ratio of 1.16 (95% Cl 1. 03 to 1.31, p = 0.01). Thus, women admitted alive to the hospital with an AMI have on increased long-term mortality that is explained by the ir older age. However, short-term mortality in women seems to increase independently of other risk factors, but is later followed by on incr ease in mortality in men.