A COMPARISON OF THE EARLY OUTCOME OF ACUTE MYOCARDIAL-INFARCTION IN WOMEN AND MEN

Background In previous studies, unadjusted comparisons of mortality an d major morbidity after acute myocardial infarction have generally ind icated that women have a poorer outcome than men. Much larger studies are needed, with more complete adjustment for coexisting conditions, t o determine whether this difference is explained by the older age of t he women studied or by the presence of other unfavorable prognostic fa ctors, or both. Methods As part of the Third International Study of ln farct Survival (ISIS-3), information was collected on deaths during da ys 0 to 35 and on major clinical events during hospitalization up to d ay 35 for 9600 women and 26,480 men with suspected acute myo cardial i nfarction who were considered to have a clear indication for fibrinoly tic therapy, We compared the outcome among women and men, first withou t adjustment, then with adjustment for age, and finally with adjustmen t for other recorded baseline characteristics by means of multiple log istic regression. Results The unadjusted odds ratio for death among wo men as compared with men was 1.73 (95 percent confidence interval, 1.6 1 to 1.86). The women were significantly older than the men, and after adjustment for age the odds ratio was reduced markedly to 1.20 (95 pe rcent confidence interval, 1.11 to 1.29), Adjustment for other differe nces in base-line clinical features further reduced the odds ratio to 1.14 (95 percent confidence interval, 1.05 to 1.23), Excesses in other major clinical events among women were generally reduced to a similar extent by adjustment. Conclusions It seems likely that there is at mo st only a small independent association between female sex and early m ortality and morbidity after suspected acute myocardial infarction. (C ) 1998, Massachusetts Medical Society.