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Sex differences in survival after MI vary by age, out-of-hospital death
There were no significant sex differences in survival after MI when adjusting for comorbidities, except in older women and when CHD deaths outside of the hospital were included, in which women had increased survival, according to a recent study.
“Young but not older women hospitalized with acute MI have been reported to have a worse prognosis than men. However, out-of-hospital deaths account for the absolute majority of all deaths from CHD but are commonly disregarded when comparing short-term prognosis in men and women after an acute coronary event,” Johanna Berg, PhD, of the department of molecular and clinical medicine at Sahlgrenska Academy at the University of Gothenburg, Sweden, and colleagues wrote.
Berg and colleagues conducted an observational study in Sweden of 658,110 participants (35.7% women) from 1987 to 2010 with first-time acute MI aged 35 to 84 years and used data from Swedish death and hospital registries.
During the study period, mortality at 28 days after MI decreased from 23.5% to 8.5% (P < .05).
Among patients hospitalized from 2005 to 2010, short-term survival was worse in women aged 35 to 54 years (HR = 1.63; 95% CI, 1.28-2.08) and women aged 55 to 64 years (HR = 1.28; 95% CI, 1.12-1.46) vs. men of the same age. However, after adjustment for comorbidities, the differences between men and women were no longer significant (aged 35 to 54 years, HR = 1.25; 95% CI, 0.97-1.61; aged 55 to 64 years, HR = 1.05; 95% CI, 0.91-1.2).
Women had better survival than men when CHD deaths outside the hospital were included, regardless of age and period.
In participants who survived the first 28 days, 1-year mortality decreased during the study period from 15.3% to 7.7% (P < .05) for both men and women.
After adjustment for comorbidities, no significant sex differences existed in survival after MI for participants younger than 75 years. Women who were aged 75 to 84 years and survived 28 days after MI had consistently better prognosis than men of the same age.
“One-year case fatality has decreased in both men and women, but women still have a poorer prognosis before the age of 75 years,” the researchers wrote. “Some of the poorer survival among women compared with men can be explained by comorbidities. Given the overall better survival in women, however, this means that younger women stand to lose more of their remaining potential life years than men. Treatment of comorbidities in women should probably receive more attention.” – by Cassie Homer
Disclosures: The authors report no relevant financial disclosures.