title: Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality.
abstract: BACKGROUND
  Women are generally older than men at hospitalization for myocardial infarction (MI) and also present less frequently with chest pain/discomfort. However, few studies have taken age into account when examining sex differences in clinical presentation and mortality.
  
  
  OBJECTIVE
  To examine the relationship between sex and symptom presentation and between sex, symptom presentation, and hospital mortality, before and after accounting for age in patients hospitalized with MI.
  
  
  METHODS
  Observational study from the National Registry of Myocardial Infarction, 1994-2006, of 1,143,513 registry patients (481,581 women and 661,932 men).
  
  
  METHODS
  We examined predictors of MI presentation without chest pain and the relationship between age, sex, and hospital mortality.
  
  
  RESULTS
  The proportion of MI patients who presented without chest pain was significantly higher for women than men (42.0% [95% CI, 41.8%-42.1%] vs 30.7% [95% CI, 30.6%-30.8%]; P < .001). There was a significant interaction between age and sex with chest pain at presentation, with a larger sex difference in younger than older patients, which became attenuated with advancing age. Multivariable adjusted age-specific odds ratios (ORs) for lack of chest pain for women (referent, men) were younger than 45 years, 1.30 (95% CI, 1.23-1.36); 45 to 54 years, 1.26 (95% CI, 1.22-1.30); 55 to 64 years, 1.24 (95% CI, 1.21-1.27); 65 to 74 years, 1.13 (95% CI, 1.11-1.15); and 75 years or older, 1.03 (95% CI, 1.02-1.04). Two-way interaction (sex and age) on MI presentation without chest pain was significant (P < .001). The in-hospital mortality rate was 14.6% for women and 10.3% for men. Younger women presenting without chest pain had greater hospital mortality than younger men without chest pain, and these sex differences decreased or even reversed with advancing age, with adjusted OR for age younger than 45 years, 1.18 (95% CI, 1.00-1.39); 45 to 54 years, 1.13 (95% CI, 1.02-1.26); 55 to 64 years, 1.02 (95% CI, 0.96-1.09); 65 to 74 years, 0.91 (95% CI, 0.88-0.95); and 75 years or older, 0.81 (95% CI, 0.79-0.83). The 3-way interaction (sex, age, and chest pain) on mortality was significant (P < .001).
  
  
  CONCLUSIONS
  In this registry of patients hospitalized with MI, women were more likely than men to present without chest pain and had higher mortality than men within the same age group, but sex differences in clinical presentation without chest pain and in mortality were attenuated with increasing age.
authors.affiliation: Watson Clinic and Lakeland Regional Medical Center, Lakeland, Florida 33805, USA. jcanto@watsonclinic.com
authors.forename: John G
authors.initials: JG
authors.lastname: Canto
authors.forename: William J
authors.initials: WJ
authors.lastname: Rogers
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Nanette K
authors.initials: NK
authors.lastname: Wenger
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.forename: Catarina I
authors.initials: CI
authors.lastname: Kiefe
authors.forename: Paul D
authors.initials: PD
authors.lastname: Frederick
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Zhi-Jie
authors.initials: ZJ
authors.lastname: Zheng
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D012042:Registries / Q000706:statistics & numerical data; D012737:Sex Factors; D014481:United States / Q000453:epidemiology