Trends in gender difference in mortality after acute myocardial infarction

Progress in management of acute myocardial infarction (AMI) might have changed the effect of gender on mortality.

From May 1981 to November 2002, 1984 consecutive patients with AMI underwent emergency coronary angiography. They were divided into three groups in chronological order: group I (1981-1988, n=564); group II (1989-1995, n=678); and group III (1997-2002, n=742). Multi-variable analysis was performed using Cox's proportional hazard regression, adjusting baseline clinical and angiographical variables.

There were 405 women (20%). Thrombolysis was most frequently performed in group I (50%), balloon angioplasty in group II (71%), and stent in group III (66%), with no difference in the allocation of reperfusion therapy between men and women. Three-year mortality was significantly higher in women than in men in group I (27% vs 18%, p=0.03) and group II (23% vs 15%, p=0.048). In group III, there was no significant difference in 3-year mortality (12% vs 10%, p=0.66) between women and men. Women were associated with higher age, more diabetes, more hypertension, fewer current smokers, and less previous infarction than men. Multi-variable analysis showed that sex was not an independent predictor of 3-year mortality in the three groups.

Women with AMI who were treated mostly with primary intervention using stent in the contemporary era had similar mortality to men.