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Acute myocardial infarction in women: survival analysis in first six months

Department of Environmental Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT Department of Cardiology, Newham General Hospital, London E13 8SL Department of Public Health Medicine, East London and The City Health Authority, London E3 2AN Department of Cardiology, London Chest Hospital, London E2 9JX Correspondence to: Dr Timmis.

Abstract

Objective : To examine the influence that being female has on the outcome of acute myocardial infarction.
Design : Observational follow up study.
Setting : London district general hospital.
Patients : 216 women and 607 men with acute myocardial infarction admitted to a coronary care unit from 1 January 1988 to 31 December 1992.
Main outcome measures : All cause mortality and recurrent ischaemic events in the first six months.
Results : Event free survival (95% confidence interval) at six months was 63.3% (56.3% to 69.4%) in women and 76.1% (72.4% to 79.4%) in men, P<0.001. The difference was confined to the first 30 days but thereafter the hazard plots for women and men converged, with reduction of the hazard ratio from 2.36 (1.70 to 3.27) to 0.81 (0.44 to 1.48). Women were older, but their excess risk persisted after adjustment for age, other baseline variables, and indices of severity of infarction (hazard ratio 1.53 (1.09 to 2.15), P=0.015). Women tended to be treated with thrombolysis less commonly than men but the difference was small. Substantially fewer women than men, however, were discharged taking ß blockers (23.3% v 41.4%, P <0.001), and although additional adjustment for discharge treatment did not further reduce the point estimate of the hazard ratio (1.84 (0.89-3.83)), the 95% confidence interval was wide and statistical significance was lost.
Conclusions : Women with acute myocardial infarction have a worse prognosis than men but the excess risk is confined to the first 30 days and is only party explained by age and other baseline variables. The tendency for women to receive less vigorous treatment than men must be remedied before gender can be considered to be an independent determinant of risk.

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