[Gender-Specific Lethality in Myocardial Infarction: A Regional and Temporal Analysis]

Epidemiological indicators form the statistical basis for medical research questions and influence how the relevance of a research topic is perceived. Temporal, financial, and human resources are invested to improve healthcare based on empirical evidence. While indicators such as morbidity and mortality are widely reported and describe the number of disease and death cases in relation to the total population, lethality - defined as the proportion of deaths among those actually affected - receives far less attention. From a gender-sensitive perspective, knowledge of the 30-day lethality rate is essential to assess treatment outcomes in women and men. This raises the question of whether current data in Germany are sufficient to enable regional and temporal analyses of lethality among women and men following myocardial infarction.

A systematic PubMed search (PRISMA, 28 January 2025) identified publications (2017-2025) reporting sex-specific 28-day lethality after acute myocardial infarction (AMI). Evidence was assessed using the GRADE system. In addition, a secondary analysis of publicly available datasets (Destatis, MONICA/KORA, RHESA, GBE-Bund) was conducted. AMI cases were defined via ICD-10 I21.0-I21.9 (first infarctions). Results The search identified 18 relevant publications. Three studies of high methodological quality (AOK, MONICA/KORA, GBE-Bund) consistently showed higher 28-day lethality in women (RR 1.12-1.30), especially in individuals under 60 years; in older age groups, differences diminished. Marked regional disparities were observed, with higher lethality rates in eastern German states (e. g., Brandenburg 19%, Berlin 12%).

These findings reveal a rudimentary data landscape regarding 30-day mortality after acute coronary syndrome or myocardial infarction. Known factors, such as earlier diagnosis in men, differences in risk profiles, and treatment disparities, can partly explain the observed trends. However, robust, evidence-based analyses and datasets enabling sex- and age-specific evaluations are lacking. Consistent inclusion of post-discharge follow-up data is essential to fully capture care quality and to develop targeted, gender-sensitive prevention and treatment strategies.