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Differences Between Women and Men in Survival After Myocardial Infarction: Title and subTitle BreakBiology or Methodology? FREE

Nicholas H. Fiebach, MD; Catherine M. Viscoli, MPhil; Ralph I. Horwitz, MD
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Reprint requests to Primary Care Center, Yale University, 20 York St, New Haven, CT 06504 (Dr Fiebach).


JAMA. 1990;263(8):1092-1096. doi:10.1001/jama.1990.03440080070026
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To examine the impact of gender on survival after myocardial infarction, we performed a retrospective cohort study of 332 women and 790 men. Women who had a myocardial infarction were older and more often had hypertension, diabetes, previous heart failure, and impaired left ventricular function on admission. Cumulative 3-year mortality and in-hospital mortality rates were significantly higher in women than men, but mortality among hospital survivors was similar. After multivariate adjustment for baseline differences, mortality rates were not significantly different between women and men for in-hospital deaths, and mortality at 3 years among hospital survivors tended to be lower among women. We conclude that higher observed mortality rates following a myocardial infarction in women are related to differences in known risk factors for subsequent mortality and that gender should not be considered an independent risk factor for mortality after myocardial infarction.

(JAMA. 1990;263:1092-1096)

REFERENCES

Gomez-Marin O, Folsom AR, Kottke TE, et al.  Improvement in long-term survival among patients hospitalized with acute myocardial infarction, 1970-1980 . N Engl J Med. 1987;;316:1353-1359.
Tofler GH, Stone PH, Muller JE, et al.  Effects of gender and race on prognosis after myocardial infarction: adverse prognosis for women, particularly black women . J Am Coll Cardiol. 1987;;9:473-482.
Dittrich H, Gilpin E, Nicod P, Cali G, Henning H, Ross J Jr.  Acute myocardial infarction in women: influence of gender on mortality and prognostic variables . Am J Cardiol. 1988;;62:1-7.
Puletti M, Sunseri L, Curione M, Erba SM, Borgia C.  Acute myocardial infarction: sex-related differences in prognosis . Am Heart J. 1984;;108:63-66.
Horwitz RI, Viscoli CM, Sadock RT.  Replication of randomized trial results by an improved cohort method that removes the bias of customary cohort research . Clin Res. 1988;;36:547A. Abstract.
Killip T, Kimball JT.  Treatment of myocardial infarction in a coronary care unit: a two year experience with 250 patients . Am J Cardiol. 1967;;20:457-464.
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research: Principles and Quantitative Methods. New York, NY: Van Nostrand Reinhold Co ; 1982;:99;419-456.
National Center for Health Statistics. Health, United States, 1986 . Washington, DC: US Public Health Service; 1986;. Dept of Health and Human Services publication (PHS) 87-1232.
Johansson S, Bergstrand R, Ulvenstam G, et al.  Sex differences in preinfarction characteristics and long-term survival among patients with myocardial infarction . Am J Epidemiol. 1984;;119:610-623.
Kannel WB, Sorlie P, McNamara PM.  Prognosis after initial myocardial infarction: the Framingham study . Am J Cardiol. 1979;;44:53-59.
Davis HT, DeCamilla J, Bayer L, Moss AJ.  Survivorship patterns in the posthospital phase of myocardial infarction . Circulation. 1979;;60:1252-1258.
Merrilees MA, Scott PJ, Norris RM.  Prognosis after myocardial infarction: results of 15 year follow up . Br Med J. 1984;;288:356-359.
Pohjola S, Siltanen P, Romo M.  Five-year survival of 728 patients after myocardial infarction: a community study . Br Heart J. 1980;;43:176-183.
Martin CA, Thompson PL, Armstrong BK, Hobbs MS, DeKlerk N.  Long-term prognosis after recovery from myocardial infarction: a nine year follow-up of the Perth Coronary Register . Circulation . 1983;;68:961-969.
Peter T, Harper R, Luxton M, Penington C, Sloman JG.  Acute myocardial infarction in women: the influence of age on complications and mortality . Med J Aust. 1978;;1:189-191.
The Multicenter Postinfarction Research Group.  Risk stratification and survival after myocardial infarction . N Engl J Med. 1983;;309:331-336.
Roberts R, Croft C, Gold HK, et al.  Effect of propranolol on myocardial-infarct size in a randomized blinded multicenter trial . N Engl J Med. 1984;; 311:218-225.
Mukharji J, Rude RE, Poole K, et al.  Risk factors for sudden death after acute myocardial infarction: two-year follow-up . Am J Cardiol. 1984;;54:31-36.
The Beta-Blocker Pooling Project Research Group.  The Beta-Blocker Pooling Project (BBPP): subgroup findings from randomized trials in post infarction patients . Eur Heart J. 1988;;9:8-16.
Turi ZG, Stone PH, Muller JE, et al.  Implications for acute intervention related to time of hospital arrival in acute myocardial infarction . Am J Cardiol. 1986;;58:203-209.
Tobin JN, Wassertheil-Smoller S, Wexler JP, et al.  Sex bias in considering coronary bypass surgery . Ann Intern Med. 1987;;107:19-25.

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Gomez-Marin O, Folsom AR, Kottke TE, et al.  Improvement in long-term survival among patients hospitalized with acute myocardial infarction, 1970-1980 . N Engl J Med. 1987;;316:1353-1359.
Tofler GH, Stone PH, Muller JE, et al.  Effects of gender and race on prognosis after myocardial infarction: adverse prognosis for women, particularly black women . J Am Coll Cardiol. 1987;;9:473-482.
Dittrich H, Gilpin E, Nicod P, Cali G, Henning H, Ross J Jr.  Acute myocardial infarction in women: influence of gender on mortality and prognostic variables . Am J Cardiol. 1988;;62:1-7.
Puletti M, Sunseri L, Curione M, Erba SM, Borgia C.  Acute myocardial infarction: sex-related differences in prognosis . Am Heart J. 1984;;108:63-66.
Horwitz RI, Viscoli CM, Sadock RT.  Replication of randomized trial results by an improved cohort method that removes the bias of customary cohort research . Clin Res. 1988;;36:547A. Abstract.
Killip T, Kimball JT.  Treatment of myocardial infarction in a coronary care unit: a two year experience with 250 patients . Am J Cardiol. 1967;;20:457-464.
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research: Principles and Quantitative Methods. New York, NY: Van Nostrand Reinhold Co ; 1982;:99;419-456.
National Center for Health Statistics. Health, United States, 1986 . Washington, DC: US Public Health Service; 1986;. Dept of Health and Human Services publication (PHS) 87-1232.
Johansson S, Bergstrand R, Ulvenstam G, et al.  Sex differences in preinfarction characteristics and long-term survival among patients with myocardial infarction . Am J Epidemiol. 1984;;119:610-623.
Kannel WB, Sorlie P, McNamara PM.  Prognosis after initial myocardial infarction: the Framingham study . Am J Cardiol. 1979;;44:53-59.
Davis HT, DeCamilla J, Bayer L, Moss AJ.  Survivorship patterns in the posthospital phase of myocardial infarction . Circulation. 1979;;60:1252-1258.
Merrilees MA, Scott PJ, Norris RM.  Prognosis after myocardial infarction: results of 15 year follow up . Br Med J. 1984;;288:356-359.
Pohjola S, Siltanen P, Romo M.  Five-year survival of 728 patients after myocardial infarction: a community study . Br Heart J. 1980;;43:176-183.
Martin CA, Thompson PL, Armstrong BK, Hobbs MS, DeKlerk N.  Long-term prognosis after recovery from myocardial infarction: a nine year follow-up of the Perth Coronary Register . Circulation . 1983;;68:961-969.
Peter T, Harper R, Luxton M, Penington C, Sloman JG.  Acute myocardial infarction in women: the influence of age on complications and mortality . Med J Aust. 1978;;1:189-191.
The Multicenter Postinfarction Research Group.  Risk stratification and survival after myocardial infarction . N Engl J Med. 1983;;309:331-336.
Roberts R, Croft C, Gold HK, et al.  Effect of propranolol on myocardial-infarct size in a randomized blinded multicenter trial . N Engl J Med. 1984;; 311:218-225.
Mukharji J, Rude RE, Poole K, et al.  Risk factors for sudden death after acute myocardial infarction: two-year follow-up . Am J Cardiol. 1984;;54:31-36.
The Beta-Blocker Pooling Project Research Group.  The Beta-Blocker Pooling Project (BBPP): subgroup findings from randomized trials in post infarction patients . Eur Heart J. 1988;;9:8-16.
Turi ZG, Stone PH, Muller JE, et al.  Implications for acute intervention related to time of hospital arrival in acute myocardial infarction . Am J Cardiol. 1986;;58:203-209.
Tobin JN, Wassertheil-Smoller S, Wexler JP, et al.  Sex bias in considering coronary bypass surgery . Ann Intern Med. 1987;;107:19-25.
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