MORTALITY DIFFERENCES BETWEEN MEN AND WOMEN FOLLOWING FIRST MYOCARDIAL-INFARCTION

Context.-Mortality after acute myocardial infarction is worse in women than in men, even after adjustment for comorbidity and age dissimilar ities between sexes. Objective.-To assess the influence of sex on surv ival after acute myocardial infarction. Design.-Inception cohort obtai ned in a prospective registry of patients with acute myocardial infarc tion from 1992 through 1994. Setting.-Four teaching hospitals in north eastern Spain. Patients.-All consecutive patients aged 80 years or you nger with first acute myocardial infarction. A total of 331 women and 1129 men were included. Main Outcome Measure.-Survival at 28 days and mortality or readmission at 6 months, Results.-Women were older (mean, 68.6 vs 60.1 years), presented more often with diabetes (52.9% vs 23. 3%), hypertension (63.9% vs 42.3%), or previous angina (44.6% vs 37.4% ), and developed more severe myocardial infarctions than men (acute pu lmonary edema or cardiogenic shock occurred in 24.8% of women and 10.5 % of men) tall P<.02). Men were more likely than women to receive thro mbolytic therapy (41.3% vs 23.9%; P<.001), but rates of percutaneous t ransluminal angioplasty and coronary artery bypass graft surgery at 28 days were similar among men and women, The 28-day mortality rate was significantly higher among women (18.5% for women, 8.3% for men; P<.00 1). Revascularization procedures at 6 months were performed in a simil ar proportion of women and men. However, women had higher 6-month mort ality rates (25.8% in women, 10.8% in men; P<.001) and readmission rat es (23.3% for women, 12.2% for men; P<.001). After adjustment, women h ad greater risk of death than men at 28 days (odds ratio [OR], 1.72; 9 5% confidence interval [CI], 1.12-2.65) and at 6 months (OR, 1.73; 95% ci, 1.18-2.52). Conclusions.-In this study population, women experien ced more lethal and severe first acute myocardial infarction than men, regardless of comorbidity, age, or previous angina.