Article Text
Abstract
Objective In this nationwide study, we investigated age-specific and sex-specific trends in sex differences in survival after acute myocardial infarction (AMI), including deaths from coronary heart disease (CHD) that occurred outside hospital.
Methods Observational study in Sweden of 28-day and 1-year mortality among 658 110 persons (35.7% women) aged 35–84 years with a first-time CHD event 1987–2010 with data retrieved from the national Swedish death and hospital registries.
Results Age-adjusted 28-day case fatality decreased from 23.5% to 8.5% over the period (p<0.05). In hospitalised cases, short-term survival in women aged 35–54 years compared with men of the same age was poorer, not changing appreciably over time (HRs for women relative to men 1.63 (95% CI 1.28 to 2.08) at age 35–54 years and 1.28 (95% CI 1.12 to 1.46) at age 55–64 years in 2005–2010), but after adjustment for comorbidities, differences between men and women were no longer significant (HR 1.25 (95% CI 0.97 to 1.61) and 1.05 (95% CI 0.91 to 1.20)). When CHD deaths outside hospital were included, women had better prognosis regardless of age and period. In patients surviving the first 28 days, age-adjusted 1-year case fatality decreased from 15.3% to 7.7% (p<0.05) for both men and women. After adjustment for comorbidities, no significant sex differences persisted below the age of 75 years in the last period. Female 28-day survivors 75–84 years old had a consistently better prognosis than older men.
Conclusions The worse short-term outcomes in women <55 years of age hospitalised with AMI did not persist after adjustment for comorbidities. When CHD deaths outside hospital were included, women had consistently better short-term prognosis. In 28-day survivors, women did not fare worse than men when differences in comorbidities were considered.
- cardiac risk factors and prevention
- coronary artery disease
- acute coronary syndromes
- epidemiology
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Footnotes
Contributors JB designed the study, performed the statistical analysis and prepared the manuscript. LB advised on the study design and interpretation of data. SN adviced on the interpretation of data. GL was responsible for data collection and statistical advice. AR advised on the study design and interpretation of data. All authors contributed to the study design, read, critically revised and approved the final manuscript.
Funding The study was financed by grants from the Swedish state, under the agreement between the Swedish government and the county councils concerning economic support of research and education of doctors (ALF agreement), the Health and Medical Care Committee of the Regional Executive Board, Region Västra Götaland, Sweden; the Swedish Heart and Lung Foundation (201500438); the Swedish Research Council (201305187, 201304236) and the Swedish Council for Health, Working Life and Welfare (FORTE) (200702280, 201300325).
Competing interests None declared.
Ethics approval The Regional Ethics Board of Gothenburg, Sweden.
Provenance and peer review Not commissioned; externally peer reviewed.