Marked improvement in survival after acute myocardial infarction in middle-aged men but not in women. The Northern Sweden MONICA study 1985-94

Objectives. The aim of this study was to analyse time trends in survival af ter acute myocardial infarction with special emphasis on sex differences. Design. Within the framework of the population-based WHO MONICA Project, al l acute myocardial infarction events were recorded in the age group 25-64 y ears in northern Sweden during the period 1985-94. All first-ever myocardia l infarction patients were followed for information on vital status. Subjects. A total of 3397 men and 860 women with acute myocardial infarctio n, during the period between 1985 and 1994. Main outcome measures. Case fatality rates after first-ever acute myocardia l infarction. Results. When compared with the 1985-86 cohort, the age-adjusted odds ratio for death within 1 year after acute myocardial infarction was 0.59 (95% CI 0.46-0.76) in the 1993-94 male cohort but 0.99 (95% CI 0.61-1.60) in the f emale 1993-94 cohort. Corresponding age-adjusted proportions of death withi n 1 year were 33.3% and 22.9% in men and 27.5% and 27.3% in women in 1985-8 6 and 1993-94, respectively. The odds ratio for 3-year case fatality amongs t those who survived the first 28 days was 0.34 (95% CI 0.21-0.55) in 1991- 92 compared with 1985-86 in men and 0.91 (0.43-1.94) in women. Conclusion. Both short- and long-term survival after AMI have improved mark edly in men over the last decade. There is a disturbing sex difference in t hat, during the same period, survival in women with AMI has not improved at all. This sex difference was not explained by differences in conventional prognostic factors.