title: Sex differences in acute myocardial infarction: Is it only the age?
abstract: BACKGROUND
  Several studies have shown that, after an acute myocardial infarction, women have worse prognosis than males. However, it is not clear if female sex is an independent predictor of mortality risk. Our aim was to analyse sex influence on the prognosis of these patients.
  
  
  METHODS
  Retrospective registry of patients with ST segment elevation myocardial infarction (STEMI) from January 2010 to April 2015.
  
  
  RESULTS
  From 1111 patients, 258 (23.2%) were women. Compared with men, they presented higher risk profiles with older age (70.1±14.4years vs. 62.3±13.4, P<0.001), more cardiovascular risk factors (except smoking), longer time from symptoms onset to hospital arrival (5.2±4.1h vs. 4.2±3.7), higher Killip classification (1.6±1.1 vs. 1.4±0.8), fewer complete revascularizations (175 [67.8%] vs. 662 [77.9%] in men) and higher in-hospital mortality (26 [10.1%] vs. 34 [4.0%]); all p values <0.003. At discharge, women less frequently received ACE inhibitors (189 [81.1%] vs. 702 [85.8%], p=0.045) and presented more major adverse events (death, bleeding, infection, myocardial infarction, stent thrombosis or heart failure) during the first month after discharge (10.5% vs. 4.5%, p<0.001) and higher long-term mortality (hazard ratio [HR] 1.6, 95% CI 1.1-2.2). After adjusting by age, most of the differences disappeared, and sex was not an independent factor of in-hospital (odds ratio 1.71, 95% CI 0.97-2.99) or long-term mortality (HR 1.0, 95% CI 0.7-1.5).
  
  
  CONCLUSIONS
  In patients with acute STEMI, the association of female sex with poor prognosis is mainly explained by age. Sex does not seem to be an independent prognostic factor.
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Valero-Masa
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Velásquez-Rodríguez
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Diez-Delhoyo
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Devesa
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Miriam
authors.initials: M
authors.lastname: Juárez
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Iago
authors.initials: I
authors.lastname: Sousa-Casasnovas
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: Angulo-Llanos
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Complutense, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Complutense, Madrid, Spain; Universidad Europea, Madrid, Spain. Electronic address: mmselles@secardiologia.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Martínez-Sellés
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality*; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology
keywords: Age; Mortality; Myocardial infarction; Outcomes; Prognosis; Sex