SEX-RELATED DIFFERENCES IN SHORT AND LONG-TERM PROGNOSIS AFTER ACUTE MYOCARDIAL-INFARCTION - 10-YEAR FOLLOW-UP OF 3073 PATIENTS IN DATABASEOF FIRST DANISH VERAPAMIL INFARCTION TRIAL

Objective-To re-examine the prevailing hypothesis that women fare wors e than men after acute myocardial infarction. Design-10 year follow up of all patients with confirmed acute myocardial infarction registered in the database of the Danish verapamil infarction trial in 1979-81. Setting-16 coronary care units, covering a fifth of the total Danish p opulation. Patients-3073 consecutive patients with acute myocardial in farction, 738 (24%) women and 2335 (76%) men. Main outcome measures-Ea rly mortality (before day 15). For patients alive on day 15: mortality , cause of death, admission with recurrent infarction, and mortality a fter reinfarction. Results-Early mortality increased significantly wit h age (P<0.0001) but was not significantly related to sex, with a 15 d ay mortality of 17% in women and 16% in men. Adjustment for age and se x simultaneously revealed a significant interaction (P=0.02) between t hese variables, with a greater increase with age in early mortality fo r men than for women (early mortality was equal for the two sexes at a ge 64 years). Ten year mortality in patients alive on day 15 was 58.8% . The overall age adjusted hazard ratio (95% confidence interval) for women versus men was 0.90 (0.80 to 1.01); 0.90 (0.78 to 1.04) for 10 y ear reinfarction (48.8%); and 0.98 (0.82 to 1.16) for 10 year mortalit y after reinfarction (82.3%). No difference in cause of death was foun d between the sexes. With a follow up of up to 10 years for patients a live on day 15 mortality, rate of reinfarction, and mortality after re infarction increased with increasing age (P<0.0001). Conclusion-Sex by itself is not a risk factor after acute myocardial infarction.