Gender and survival: A population-based study of 201,114 men and women following a first acute myocardial infarction

OBJECTIVES We tested the hypotheses that the effect of gender on short-term case fatality following a first admission for acute myocardial infarction (AMI) varies with age, and that this effect is offset by differences in the proportion of men and women who survive to reach hospital. BACKGROUND Evidence is conflicting regarding the effect of gender on progno sis after AMI. METHODS All 201,114 first AMIs between 1986 and 1995 were studied. Both 30- day and 1-year case fatality were analyzed for the 117,749 patients hospita lized and for all first AMIs, including deaths before hospitalization. The effect of gender and its interaction with age on survival was examined usin g multivariate modeling. RESULTS Gender-based differences in survival varied according to age in hos pitalized patients, with younger women having higher 30-day case fatality t han men (e.g., < 55 years, women 6.5% vs. 4.8% men, p <0.0001). When deaths from first AMI before hospitalization were included in 30-day case fatalit y, women were less likely to die (adjusted odds ratio 0.9, confidence inter val 0.89 to 0.93). Gender was not an independent predictor of one-year surv ival (p=0.16). CONCLUSIONS Female gender increases the probability of surviving to reach h ospital, and this outweighs the excess risk of death occurring in younger w omen following hospitalization. Overall, men have a higher 30-day case fata lity than women. Women do not fare worse than men after AMI when age and ot her factors are taken into account. However, men are more likely to die bef ore hospitalization. (C) 2001 by the American College of Cardiology.