Sex-based short- and long-term survival in patients following complicated myocardial infarction
Vernon V S Bonarjee1, Annika Rosengren, Steven M Snapinn
1University of Bergen, Stavanger University Hospital, Stavanger, Norway. bove@sir.no
Insights
Women with acute myocardial infarction (AMI) face higher in-hospital mortality, despite similar long-term survival after age adjustment. This highlights the need for prompt, tailored management for female AMI patients.
Area of Science:
- Cardiology
- Clinical Research
- Sex Differences in Medicine
Background:
- Mortality after acute myocardial infarction (AMI) is higher in women than men.
- Women are typically older and have more comorbidities at the time of AMI.
Purpose of the Study:
- To investigate sex-based differences in the management and prognosis of high-risk patients post-AMI.
- To evaluate short- and long-term outcomes in women versus men following AMI.
Main Methods:
- Analysis of data from the OPTIMAAL trial, including 1575 women and 3902 men with AMI.
- Follow-up period of 2.7+/-0.9 years across seven European countries.
- Comparison of management strategies and mortality rates, adjusting for age and comorbidities.
Main Results:
- Women presented with more symptomatic heart failure, hypertension, and diabetes mellitus.
- Fewer women received thrombolytic therapy compared to men.
- While long-term mortality risk was similar after age adjustment, in-hospital mortality was significantly higher in women, persisting even after adjusting for age and comorbidities.
Conclusions:
- Age-adjusted long-term survival post-AMI is comparable between sexes in high-risk populations.
- Women experience significantly higher in-hospital mortality following AMI.
- These findings suggest a need for more rapid and appropriate management strategies for women presenting with AMI to address short-term risks.
Aims:
Mortality in women following an acute myocardial infarction (AMI) is higher than in men, in that women are older and have more co-morbidity at the time of AMI. We evaluated short- and long-term sex-related differences in management and prognosis among high-risk patients following AMI.
Methods And Results:
A total of 1575 women and 3902 men with AMI and heart failure, left ventricular dysfunction, or anterior Q waves, were recruited for participation in the OPTIMAAL trial and followed for 2.7+/-0.9 years in seven European countries. Symptomatic heart failure was more common in women when compared with men. Women were older, with more hypertension and diabetes mellitus. Fewer women were treated with thrombolytics (P<0.001 in all cases). Women had a 1.37-fold higher risks of death (P<0.001) during follow-up, but no differences were observed after adjusting for age. However, in-hospital mortality was significantly higher in women (4.89 vs. 2.54%; P<0.001) and a 1.57-fold higher risk of in-hospital death (P=0.006) persisted after adjusting for age and co-morbidities.
Conclusion:
Among high-risk patients with AMI, age-adjusted long-term survival was similar between sexes. However, adjusted in-hospital mortality was significantly higher in women. Higher short-term risk may warrant more rapid and appropriate management of women with AMI.
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