BMJ 1996;313:137-140 (20 July)

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Sex related differences in short and long term prognosis after acute myocardial infarction: 10 year follow up of 3073 patients in database of first Danish verapamil infarction trial

S Galatius-Jensen, registrar,a J Launbjerg, senior registrar,a L Spange Mortensen, statistician,b J Fischer Hansen, head of department of cardiology c

a Department of Cardiology B, National University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark, b Danish Computing Centre for Research and Education, UNI-C, Aarhus, Denmark, c Department of Cardiology, University Hospital, Hvidovre, Denmark

Correspondence and requests for reprints to: Dr Galatius-Jensen.

Abstract

Objective: To re-examine the prevailing hypothesis that women fare worse than men after acute myocardial infarction.
Design: 10 year follow up of all patients with confirmed acute myocardial infarction registered in the database of the Danish verapamil infarction trial in 1979-81.
Setting: 16 coronary care units, covering a fifth of the total Danish population.
Patients: 3073 consecutive patients with acute myocardial infarction, 738 (24%) women and 2335 (76%) men.
Main outcome measures: Early mortality (before day 15). For patients alive on day 15: mortality, cause of death, admission with recurrent infarction, and mortality after reinfarction.
Results: Early mortality increased significantly with age (P<0.0001) but was not significantly related to sex, with a 15 day mortality of 17% in women and 16% in men. Adjustment for age and sex simultaneously revealed a significant interaction (P=0.02) between these variables, with a greater increase with age in early mortality for men than for women (early mortality was equal for the two sexes at age 64 years). Ten year mortality in patients alive on day 15 was 58.8%. The overall age adjusted hazard ratio (95% confidence interval) for women versus men was 0.90 (0.80 to 1.01); 0.90 (0.78 to 1.04) for 10 year reinfarction (48.8%); and 0.98 (0.82 to 1.16) for 10 year mortality after reinfarction (82.3%). No difference in cause of death was found between the sexes. With a follow up of up to 10 years for patients alive on day 15 mortality, rate of reinfarction, and mortality after reinfarction increased with increasing age (P<0.0001).
Conclusion: Sex by itself is not a risk factor after acute myocardial infarction.

Key messages

  • Women and men have similar mortality at 10 year follow up

  • Causes of death are not different between the sexes

  • Women and men have similar reinfarction rates and similar subsequent mortality

  • The prevailing view regarding sex as an independent prognostic factor after acute myocar- dial infarction may be due to present differences in treatment of women and men, selection bias, and the interpretation of the role of age differences


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