Sex-based differences in clinical features, management, and 28-day and 7-year prognosis of first acute myocardial infarction. RESCATE II study.
OBJECTIVE
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.
Departamento de Cardiología, Hospital del Mar, Barcelona, Spain; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; Departamento de Medicina Interna, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: cgarciag@parcdesalutmar.cat.
Cosme
C
García-García
Departamento de Cardiología, Hospital del Mar, Barcelona, Spain; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, Barcelona, Spain.
Lluís
L
Molina
CIBER en Epidemiología y Salud Pública, Barcelona, Spain; Grupo de Genética y Epidemiología Cardiovascular, Institut Municipal d'Investigació Mèdica, Barcelona, Spain.
Isaac
I
Subirana
Departamento de Cardiología, Hospital Josep Trueta, Girona, Spain.
Joan
J
Sala
Departamento de Cardiología, Hospital del Mar, Barcelona, Spain; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.
Jordi
J
Bruguera
Departamento de Cardiología, Hospital Txagurritxu, Vitoria, Álava, Spain.
Fernando
F
Arós
Departamento de Cardiología, Hospital Son Espases, Palma de Mallorca, Spain; CIBER en Obesidad y Nutrición, Barcelona, Spain.
Miquel
M
Fiol
Departamento de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
Jordi
J
Serra
Grupo de Genética y Epidemiología Cardiovascular, Institut Municipal d'Investigació Mèdica, Barcelona, Spain.
Jaume
J
Marrugat
Grupo de Genética y Epidemiología Cardiovascular, Institut Municipal d'Investigació Mèdica, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, Barcelona, Spain.
Roberto
R
Elosua
D000328:Adult; D000367:Age Factors; D000368:Aged; D019090:Case Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis
AMI; Acute myocardial infarction; Gender prognosis; Infarto agudo de miocardio; NSTEMI; Pronóstico según sexo; ST-segment elevation myocardial infarction; STEMI; Sex; Sexo; acute myocardial infarction; non-ST-elevation myocardial infarction