Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2014;67:28-35 - Vol. 67 Num.01 DOI: 10.1016/j.rec.2013.06.024

Sex-based Differences in Clinical Features, Management, and 28-day and 7-year Prognosis of First Acute Myocardial Infarction. RESCATE II Study

Cosme García-García a,b,c,, Lluís Molina a,b,d, Isaac Subirana d,e, Joan Sala f, Jordi Bruguera a,b, Fernando Arós g, Miquel Fiol h,i, Jordi Serra j, Jaume Marrugat e, Roberto Elosua d,e

a Departamento de Cardiología, Hospital del Mar, Barcelona, Spain
b IMIM-Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
c Departamento de Medicina Interna, Universitat Autònoma de Barcelona, Barcelona, Spain
d CIBER en Epidemiología y Salud Pública, Barcelona, Spain
e Grupo de Genética y Epidemiología Cardiovascular, Institut Municipal d’Investigació Mèdica, Barcelona, Spain
f Departamento de Cardiología, Hospital Josep Trueta, Girona, Spain
g Departamento de Cardiología, Hospital Txagurritxu, Vitoria, Álava, Spain
h Departamento de Cardiología, Hospital Son Espases, Palma de Mallorca, Spain
i CIBER en Obesidad y Nutrición, Barcelona, Spain
j Departamento de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

Keywords

Acute myocardial infarction. Gender prognosis. Sex.

Abstract

Introduction and objectives

To analyze sex-based differences in clinical characteristics, management, and 28-day and 7-year prognosis after a first myocardial infarction.

Methods

Between 2001 and 2003, 2042 first myocardial infarction patients were consecutively registered in 6 Spanish hospitals. Clinical characteristics, management, and 28-day case-fatality were prospectively recorded. Seven-year vital status was also ascertained by data linkage with the National Mortality Index.

Results

The registry included 449 women and 1593 men with a first myocardial infarction. Compared with men, women were older, had a higher prevalence of hypertension and diabetes, and were more likely to receive angiotensin-converting enzyme (ACE) inhibitors but were less likely to receive beta-blockers or thrombolysis. No differences were observed in use of invasive procedures. More women had non-ST-segment elevation and unclassified myocardial infarction than men (37.9% vs 31.3% and 9.8% vs 6.1%, respectively; both P<.001). Case-fatality at 28 days was similar in women and men (5.57% vs 4.46%; P=.39). After multivariate adjustment, the odds ratio of 28-day mortality for men was 1.06 (95% confidence interval: 0.49-2.27; P=.883) compared with women. After multivariate adjustment, men had higher 7-year mortality than women, hazard ratio 1.93 (95% confidence interval: 1.46-2.56; P<.001).

Conclusions

There are demographic and clinical differences between men and women with a first myocardial infarction. The short-term prognosis of a first myocardial infarction in this century is similar in both sexes. However, the long-term vital prognosis after a first myocardial infarction is worse in men than in women. These results are observed in both ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction events.

1885-5857/© 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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