FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 338:8-14 January 1, 1998 Number 1 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background In previous studies, unadjusted comparisons of mortality and major morbidity after acute myocardial infarction have generally indicated that women have a poorer outcome than men. Much larger studies are needed, with more complete adjustment for coexisting conditions, to determine whether this difference is explained by the older age of the women studied or by the presence of other unfavorable prognostic factors, or both.

Methods As part of the Third International Study of Infarct Survival (ISIS-3), information was collected on deaths during days 0 to 35 and on major clinical events during hospitalization up to day 35 for 9600 women and 26,480 men with suspected acute myocardial infarction who were considered to have a clear indication for fibrinolytic therapy. We compared the outcome among women and men, first without adjustment, then with adjustment for age, and finally with adjustment for other recorded base-line characteristics by means of multiple logistic regression.

Results The unadjusted odds ratio for death among women as compared with men was 1.73 (95 percent confidence interval, 1.61 to 1.86). The women were significantly older than the men, and after adjustment for age the odds ratio was reduced markedly to 1.20 (95 percent confidence interval, 1.11 to 1.29). Adjustment for other differences in base-line clinical features further reduced the odds ratio to 1.14 (95 percent confidence interval, 1.05 to 1.23). Excesses in other major clinical events among women were generally reduced to a similar extent by adjustment.

Conclusions It seems likely that there is at most only a small independent association between female sex and early mortality and morbidity after suspected acute myocardial infarction.

Source Information

From the Medical Department, Civic Hospital, Lugano, Switzerland (R.M., M.G., V.S., T.M.); the Department of Cardiovascular Research, Mario Negri Institute, Milan, Italy (A.P.M.); and the Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom (S.P., A.P., R.C.).

Address reprint requests to Dr. Moccetti at the Medical Department, Civic Hospital, Via Tesserete 46, 6900 Lugano, Switzerland.

Full Text of this Article

Related Letters:

Comparison of the Early Outcome of Acute Myocardial Infarction in Women and Men
Khaw K.-T., Nettleman M. D., Klein W. S., Collins R., Malacrida R., Moccetti T.
Extract | Full Text  
N Engl J Med 1998; 338:1543-1544, May 21, 1998. Correspondence

This article has been cited by other articles:

• Hogarth, A. J., Graham, L. N., Mary, D. A.S.G., Greenwood, J. P. (2009). Gender differences in sympathetic neural activation following uncomplicated acute myocardial infarction. Eur Heart J 30: 1764-1770 [Abstract] [Full Text]  
• Champney, K P, Frederick, P D, Bueno, H, Parashar, S, Foody, J, Merz, C N B, Canto, J G, Lichtman, J H, Vaccarino, V, for the NRMI Investigators, (2009). The joint contribution of sex, age and type of myocardial infarction on hospital mortality following acute myocardial infarction. Heart 95: 895-899 [Abstract] [Full Text]  
• Saposnik, G., Kapral, M. K. (2009). Understanding Stroke in Women: Similar Care, Worse Outcomes?. Stroke 40: 674-675 [Full Text]  
• Jneid, H., Fonarow, G. C., Cannon, C. P., Hernandez, A. F., Palacios, I. F., Maree, A. O., Wells, Q., Bozkurt, B., LaBresh, K. A., Liang, L., Hong, Y., Newby, L. K., Fletcher, G., Peterson, E., Wexler, L., for the Get With the Guidelines Steering Committee, (2008). Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction. Circulation 118: 2803-2810 [Abstract] [Full Text]  
• DeVon, H. A., Ryan, C. J., Ochs, A. L., Shapiro, M. (2008). Symptoms Across the Continuum of Acute Coronary Syndromes: Differences Between Women and Men. Am J Crit Care 17: 14-24 [Abstract] [Full Text]  
• Kohno, H., Takahashi, N., Shinohara, T., Ooie, T., Yufu, K., Nakagawa, M., Yonemochi, H., Hara, M., Saikawa, T., Yoshimatsu, H. (2007). Receptor-Mediated Suppression of Cardiac Heat-Shock Protein 72 Expression by Testosterone in Male Rat Heart. Endocrinology 148: 3148-3155 [Abstract] [Full Text]  
• Sarrafzadegan, N., Rabiei, K., Shirani, S., Kabir, A., Mohammadifard, N., Roohafza, H. (2007). Drop-out predictors in cardiac rehabilitation programmes and the impact of sex differences among coronary heart disease patients in an Iranian sample: a cohort study. Clin Rehabil 21: 362-372 [Abstract]  
• Pilote, L., Dasgupta, K., Guru, V., Humphries, K. H., McGrath, J., Norris, C., Rabi, D., Tremblay, J., Alamian, A., Barnett, T., Cox, J., Ghali, W. A., Grace, S., Hamet, P., Ho, T., Kirkland, S., Lambert, M., Libersan, D., O'Loughlin, J., Paradis, G., Petrovich, M., Tagalakis, V. (2007). A comprehensive view of sex-specific issues related to cardiovascular disease. CMAJ 176: S1-S44 [Abstract] [Full Text]  
• Bonarjee, V. V.S., Rosengren, A., Snapinn, S. M., James, M. K., Dickstein, K., on behalf of the OPTIMAAL study group, (2006). Sex-based short- and long-term survival in patients following complicated myocardial infarction. Eur Heart J 27: 2177-2183 [Abstract] [Full Text]  
• The ESHRE Capri Workshop Group, (2006). Hormones and cardiovascular health in women. Hum Reprod Update 12: 483-497 [Abstract] [Full Text]  
• Simon, T., Mary-Krause, M., Cambou, J.-P., Hanania, G., Gueret, P., Lablanche, J.-M., Blanchard, D., Genes, N., Danchin, N., on behalf of the USIC Investigators, (2006). Impact of age and gender on in-hospital and late mortality after acute myocardial infarction: increased early risk in younger women: Results from the French nation-wide USIC registries. Eur Heart J 27: 1282-1288 [Abstract] [Full Text]  
• Martinez-Selles, M., Lopez-Palop, R., Perez-David, E., Bueno, H. (2005). Influence of Age on Gender Differences in the Management of Acute Inferior or Posterior Myocardial Infarction. Chest 128: 792-797 [Abstract] [Full Text]  
• Moriel, M., Behar, S., Tzivoni, D., Hod, H., Boyko, V., Gottlieb, S. (2005). Management and Outcomes of Elderly Women and Men With Acute Coronary Syndromes in 2000 and 2002. Arch Intern Med 165: 1521-1526 [Abstract] [Full Text]  
• Lansky, A. J., Pietras, C., Costa, R. A., Tsuchiya, Y., Brodie, B. R., Cox, D. A., Aymong, E. D., Stuckey, T. D., Garcia, E., Tcheng, J. E., Mehran, R., Negoita, M., Fahy, M., Cristea, E., Turco, M., Leon, M. B., Grines, C. L., Stone, G. W. (2005). Gender Differences in Outcomes After Primary Angioplasty Versus Primary Stenting With and Without Abciximab for Acute Myocardial Infarction: Results of the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial. Circulation 111: 1611-1618 [Abstract] [Full Text]  
• Cheng, C.-I, Yeh, K.-H., Chang, H.-W., Yu, T.-H., Chen, Y.-H., Chai, H.-T., Yip, H.-K. (2004). Comparison of Baseline Characteristics, Clinical Features, Angiographic Results, and Early Outcomes in Men vs Women With Acute Myocardial Infarction Undergoing Primary Coronary Intervention. Chest 126: 47-53 [Abstract] [Full Text]  
• Nienaber, C. A., Fattori, R., Mehta, R. H., Richartz, B. M., Evangelista, A., Petzsch, M., Cooper, J. V., Januzzi, J. L., Ince, H., Sechtem, U., Bossone, E., Fang, J., Smith, D. E., Isselbacher, E. M., Pape, L. A., Eagle, K. A., on Behalf of the International Registry of Acute A, (2004). Gender-Related Differences in Acute Aortic Dissection. Circulation 109: 3014-3021 [Abstract] [Full Text]  
• Mak, K H, Kark, J D, Chia, K S, Sim, L L, Foong, B H, Ding, Z P, Kam, R, Chew, S K (2004). Ethnic variations in female vulnerability after an acute coronary event. Heart 90: 621-626 [Abstract] [Full Text]  
• Rosengren, A., Wallentin, L., Gitt, A. K., Behar, S., Battler, A., Hasdai, D. (2004). Sex, age, and clinical presentation of acute coronary syndromes. Eur Heart J 25: 663-670 [Abstract] [Full Text]  
• Romo, H., Amaral, A. C. K.-B., Vincent, J.-L. (2004). Effect of Patient Sex on Intensive Care Unit Survival. Arch Intern Med 164: 61-65 [Abstract] [Full Text]  
• Channer, K. S., Armstrong, P. W., Antman, E. M., Zaman, A. G., Andersen, H. R., Nielsen, T. T. (2003). Coronary Angioplasty versus Fibrinolytic Therapy in Acute Myocardial Infarction. NEJM 349: 2167-2169 [Full Text]  
• Chang, W.-C., Kaul, P., Westerhout, C. M., Graham, M. M., Fu, Y., Chowdhury, T., Armstrong, P. W. (2003). Impact of Sex on Long-term Mortality From Acute Myocardial Infarction vs Unstable Angina. Arch Intern Med 163: 2476-2484 [Abstract] [Full Text]  
• Becker, A., Bos, G., de Vegt, F., Kostense, P. J, Dekker, J. M, Nijpels, G., Heine, R. J, Bouter, L. M, Stehouwer, C. D.A (2003). Cardiovascular events in type 2 diabetes: comparison with nondiabetic individuals without and with prior cardiovascular disease: 10-year follow-up of the Hoorn Study. Eur Heart J 24: 1406-1413 [Abstract] [Full Text]  
• Hochman, J. S., Tamis-Holland, J. E. (2002). Acute Coronary Syndromes: Does Sex Matter?. JAMA 288: 3161-3164 [Full Text]  
• Estess, J M, Topol, E J (2002). Fibrinolytic treatment for elderly patients with acute myocardial infarction. Heart 87: 308-311 [Full Text]  
• Mehilli, J., Kastrati, A., Dirschinger, J., Pache, J., Seyfarth, M., Blasini, R., Hall, D., Neumann, F.-J., Schomig, A. (2002). Sex-Based Analysis of Outcome in Patients With Acute Myocardial Infarction Treated Predominantly With Percutaneous Coronary Intervention. JAMA 287: 210-215 [Abstract] [Full Text]  
• Vakili, B. A., Kaplan, R. C., Brown, D. L. (2001). Sex-Based Differences in Early Mortality of Patients Undergoing Primary Angioplasty for First Acute Myocardial Infarction. Circulation 104: 3034-3038 [Abstract] [Full Text]  
• Wong, S. C., Sleeper, L. A., Monrad, E. S., Menegus, M. A., Palazzo, A., Dzavik, V., Jacobs, A., Jiang, X., Hochman, J. S., for the SHOCK Investigators, (2001). Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction: A report from the SHOCK Trial Registry. J Am Coll Cardiol 38: 1395-1401 [Abstract] [Full Text]  
• Hudson, M. P., Granger, C. B., Topol, E. J., Pieper, K. S., Armstrong, P. W., Barbash, G. I., Guerci, A. D., Vahanian, A., Califf, R. M., Ohman, E. M. (2001). Early Reinfarction After Fibrinolysis: Experience From the Global Utilization of Streptokinase and Tissue Plasminogen Activator (Alteplase) for Occluded Coronary Arteries (GUSTO I) and Global Use of Strategies To Open Occluded Coronary Arteries (GUSTO III) Trials. Circulation 104: 1229-1235 [Abstract] [Full Text]  
• MacIntyre, K., Stewart, S., Capewell, S., Chalmers, J. W. T., Pell, J. P., Boyd, J., Finlayson, A., Redpath, A., Gilmour, H., McMurray, J. J. V. (2001). Gender and survival: a population-based study of 201,114 men and women following a first acute myocardial infarction. J Am Coll Cardiol 38: 729-735 [Abstract] [Full Text]  
• Marrugat, J, Gil, M, Masia, R, Sala, J, Elosua, R, Anto, J M, the REGICOR Investigators, (2001). Role of age and sex in short-term and long term mortality after a first Q wave myocardial infarction. J. Epidemiol. Community Health 55: 487-493 [Abstract] [Full Text]  
• Humphries, K. H., Kerr, C. R., Connolly, S. J., Klein, G., Boone, J. A., Green, M., Sheldon, R., Talajic, M., Dorian, P., Newman, D. (2001). New-Onset Atrial Fibrillation : Sex Differences in Presentation, Treatment, and Outcome. Circulation 103: 2365-2370 [Abstract] [Full Text]  
• Schreiner, P.J, Niemela, M, Miettinen, H, Mahonen, M, Ketonen, M, Immonen-Raiha, P, Lehto, S, Vuorenmaa, T, Palomaki, P, Mustaniemi, H, Kaarsalo, E, Arstila, M, Torppa, J, Puska, P, Tuomilehto, J, Pyorala, K, Salomaa, V (2001). Gender differences in recurrent coronary events. The FINMONICA MI register. Eur Heart J 22: 762-768 [Abstract]  
• Vaccarino, V., Krumholz, H. M., Yarzebski, J., Gore, J. M., Goldberg, R. J. (2001). Sex Differences in 2-Year Mortality after Hospital Discharge for Myocardial Infarction. ANN INTERN MED 134: 173-181 [Abstract] [Full Text]  
• Rosengren, A, Spetz, C.-L, Koster, M, Hammar, N, Alfredsson, L, Rosen, M (2001). Sex differences in survival after myocardial infarction in Sweden. Data from the Swedish National Acute Myocardial Infarction register. Eur Heart J 22: 314-322 [Abstract]  
• Smith, P. J. W., Ornatsky, O., Stewart, D. J., Picard, P., Dawood, F., Wen, W.-H., Liu, P. P., Webb, D. J., Monge, J. C. (2000). Effects of Estrogen Replacement on Infarct Size, Cardiac Remodeling, and the Endothelin System After Myocardial Infarction in Ovariectomized Rats. Circulation 102: 2983-2989 [Abstract] [Full Text]  
• Vaccarino, V., Berkman, L. F., Krumholz, H. M. (2000). Long-term Outcome of Myocardial Infarction in Women and Men: A Population Perspective. Am J Epidemiol 152: 965-973 [Abstract] [Full Text]  
• Gottlieb, S., Harpaz, D., Shotan, A., Boyko, V., Leor, J., Cohen, M., Mandelzweig, L., Mazouz, B., Stern, S., Behar, S. (2000). Sex Differences in Management and Outcome After Acute Myocardial Infarction in the 1990s : A Prospective Observational Community-Based Study. Circulation 102: 2484-2490 [Abstract] [Full Text]  
• Mehilli, J., Kastrati, A., Dirschinger, J., Bollwein, H., Neumann, F.-J., Schomig, A. (2000). Differences in Prognostic Factors and Outcomes Between Women and Men Undergoing Coronary Artery Stenting. JAMA 284: 1799-1805 [Abstract] [Full Text]  
• Marques-Vidal, P, Ruidavets, J-B, Cambou, J-P, Ferrieres, J (2000). Incidence, recurrence, and case fatality rates for myocardial infarction in southwestern France, 1985 to 1993. Heart 84: 171-175 [Abstract] [Full Text]  
• Gan, S. C., Beaver, S. K., Houck, P. M., MacLehose, R. F., Lawson, H. W., Chan, L. (2000). Treatment of Acute Myocardial Infarction and 30-Day Mortality among Women and Men. NEJM 343: 8-15 [Abstract] [Full Text]  
• Kilaru, P. K., Kelly, R. F., Calvin, J. E., Parrillo, J. E. (2000). Utilization of coronary angiography and revascularization after acute myocardial infarction in men and women risk stratified by the American College of Cardiology/American Heart Association guidelines. J Am Coll Cardiol 35: 974-979 [Abstract] [Full Text]  
• Alpert, J.S. (2000). Concerning gender and therapy after acute myocardial infarction: are there differences between men and women?. Eur Heart J 21: 261-262  
• Crabtree, T. D., Pelletier, S. J., Gleason, T. G., Pruett, T. L., Sawyer, R. G. (1999). Gender-Dependent Differences in Outcome After the Treatment of Infection in Hospitalized Patients. JAMA 282: 2143-2148 [Abstract] [Full Text]  
• Hugel, S., Reincke, M., Stromer, H., Winning, J., Horn, M., Dienesch, C., Mora, P., Schmidt, H. H. H. W., Allolio, B., Neubauer, S. (1999). Evidence against a role of physiological concentrations of estrogen in post-myocardial infarction remodeling. J Am Coll Cardiol 34: 1427-1434 [Abstract] [Full Text]  
• Vaccarino, V., Parsons, L., Every, N. R., Barron, H. V., Krumholz, H. M., The National Registry of Myocardial Infarction 2 P, (1999). Sex-Based Differences in Early Mortality after Myocardial Infarction. NEJM 341: 217-225 [Abstract] [Full Text]  
• Hochman, J. S., Tamis, J. E., Thompson, T. D., Weaver, W. D., White, H. D., Van de Werf, F., Aylward, P., Topol, E. J., Califf, R. M., The Global Use of Strategies to Open Occluded Coro, (1999). Sex, Clinical Presentation, and Outcome in Patients with Acute Coronary Syndromes. NEJM 341: 226-232 [Abstract] [Full Text]  
• Chernow, B. (1999). Variables Affecting Outcome in Critically Ill Patients. Chest 115 : 71S-76S [Abstract] [Full Text]  
• Bing, M., Pendergrass, P. W., Gillentine, A. D., Abel, R. L. (1998). Differences in Treatment and Outcome for Women With Acute Myocardial Infarction. Arch Intern Med 158: 2513-2514 [Full Text]  
• Vaccarino, V., Horwitz, R. I., Meehan, T. P., Petrillo, M. K., Radford, M. J., Krumholz, H. M. (1998). Sex Differences in Mortality After Myocardial Infarction: Evidence for a Sex-Age Interaction. Arch Intern Med 158: 2054-2062 [Abstract] [Full Text]  
• Herzog, C. A., Ma, J. Z., Collins, A. J. (1998). Poor Long-Term Survival after Acute Myocardial Infarction among Patients on Long-Term Dialysis. NEJM 339: 799-805 [Abstract] [Full Text]  
• Khaw, K.-T., Nettleman, M. D., Klein, W. S., Collins, R., Malacrida, R., Moccetti, T. (1998). Comparison of the Early Outcome of Acute Myocardial Infarction in Women and Men. NEJM 338: 1543-1544 [Full Text]  
• (1998). Do Women Have a Worse Prognosis After MI?. JWatch Emergency Med. 1998: 6-6 [Full Text]  
• (1998). Women and Men Have Similar Risk of Early Death After MI. Journal Watch Cardiology 1998: 3-3 [Full Text]  
• (1998). Adjusted MI Mortality Still Slightly Higher in Women. JWatch Women's Health 1998: 14-14 [Full Text]