A SEX DIFFERENCE IN SHORT-TERM SURVIVAL AFTER INITIAL ACUTE MYOCARDIAL-INFARCTION - THE MONICA-BREMEN ACUTE MYOCARDIAL-INFARCTION REGISTER,1985-1990

Aims To assess the difference between men and women as regards fatalit y shortly after acute myocardial infarction, and the relationship of p atient characteristics. Methods and results One thousand seven hundred and ten male and 563 female patients, 25-69 years of age and hospital ized with a first acute myocardial infarction occurring from 1985 to 1 990, were included in the population-based World Health Organization M ONICA-Bremen Acute Myocardial Infarction Register. Patient information , including short-term survival status, was obtained from the medical records of the seven Bremen hospitals with internal medicine departmen ts and municipal death certificate files. The unadjusted 28-day fatali ty rate after acute myocardial infarction was higher among women than among men (23.1% vs 16.1%, respectively; P<0.001). Adjusting for the o lder age of women did not eliminate the difference completely (females : 20.9%, males: 16.8%; P=0.041). Controlling for previous use of inotr opic medicine and diuretics, during-the-event receipt of thrombolysis and platelet inhibitors, and age in logistic regression analyses resul ted in a similar 28-day mortality risk after acute myocardial infarcti on for both sexes (female/male odds ratio=1.13, 95% confidence interva l=0.86-1.50; P=0.389). Conclusions Sex was not an independent predicto r of early acute myocardial infarction fatality. Our data suggest that the excess mortality risk in women can be explained by sex difference s in age, pre-infarction cardiac impairment, and treatment during the coronary event.