Circulation, Vol 83, 484-491, Copyright © 1991 by American Heart Association
P Greenland, H Reicher-Reiss, U Goldbourt and S Behar
We determined in-hospital and 1-year prognoses after acute myocardial
infarction (MI) in 5,839 consecutive patients derived from 14 of 21
coronary care units in Israel during 1981-1983. Age-adjusted in- hospital
mortality was 23.1% in 1,524 women and 15.7% in 4,315 men (p less than
0.0005). One-year age-adjusted mortality rates in patients surviving
hospitalization were 11.8% in women and 9.3% in men (p = 0.03). Cumulative
age-adjusted 1-year mortality rates were 31.8% in women and 23.1% in men (p
less than 0.0005). Relative odds of mortality, covariate-adjusted for major
prognostic factors that included age, prior MI, congestive heart failure,
and infarct location by electrocardiogram, indicated that female gender was
independently and significantly associated with increased mortality both
during hospitalization (relative odds, 1.72; 95% confidence interval, 1.45-
2.04) and at 1 year after discharge (relative odds, 1.32; 95% confidence
interval, 1.05-1.66). In separate multivariate analyses for each gender, a
major factor that emerged as a predictor of outcome in women, but not in
men, was a reported history of diabetes mellitus, both for in-hospital
mortality and for 1-year mortality. However, even in the nondiabetics in
this population, female gender was a significant, independent predictor of
in-hospital mortality. The findings of the present study substantiate that
women fare worse than men after suffering an acute MI, that increased age
does not fully account for the increased mortality in women, and that
diabetic women are at particularly high risk once MI has occurred.
ARTICLES
In-hospital and 1-year mortality in 1,524 women after myocardial infarction. Comparison with 4,315 men
Neufeld Cardiac Research Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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H. Tunstall-Pedoe, C. Morrison, M. Woodward, B. Fitzpatrick, and G. Watt Sex Differences in Myocardial Infarction and Coronary Deaths in the Scottish MONICA Population of Glasgow 1985 to 1991 : Presentation, Diagnosis, Treatment, and 28-Day Case Fatality of 3991 Events in Men and 1551 Events in Women Circulation, June 1, 1996; 93(11): 1981 - 1992. [Abstract] [Full Text]
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P. H. Stone, B. Thompson, H. V. Anderson, M. W. Kronenberg, R. S. Gibson, W. J. Rogers, D. J. Diver, P. Theroux, J. W. Warnica, J. B. Nasmith, et al. Influence of Race, Sex, and Age on Management of Unstable Angina and Non--Q-Wave Myocardial Infarction: The TIMI III Registry JAMA, April 10, 1996; 275(14): 1104 - 1112. [Abstract] [PDF]
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W. D. Weaver, H. D. White, R. G. Wilcox, P. E. Aylward, D. Morris, A. Guerci, E. M. Ohman, G. I. Barbash, A. Betriu, Z. Sadowski, et al. Comparisons of Characteristics and Outcomes Among Women and Men With Acute Myocardial Infarction Treated With Thrombolytic Therapy JAMA, March 13, 1996; 275(10): 777 - 782. [Abstract] [PDF]
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J. Villacastin, J. Almendral, A. Arenal, J. Albertos, J. Ormaetxe, R. Peinado, H. Bueno, J. L. Merino, A. Pastor, O. Medina, et al. Incidence and Clinical Significance of Multiple Consecutive, Appropriate, High-Energy Discharges in Patients With Implanted Cardioverter-Defibrillators Circulation, February 15, 1996; 93(4): 753 - 762. [Abstract] [Full Text]
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D. Waters, L. Higginson, P. Gladstone, S. J. Boccuzzi, T. Cook, and J. Lesperance Effects of Cholesterol Lowering on the Progression of Coronary Atherosclerosis in Women : A Canadian Coronary Atherosclerosis Intervention Trial (CCAIT) Substudy Circulation, November 1, 1995; 92(9): 2404 - 2410. [Abstract] [Full Text]
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H. Bueno, M. T. Vidan, A. Almazan, J. L. Lopez-Sendon, and J. L. Delcan Influence of Sex on the Short-term Outcome of Elderly Patients With a First Acute Myocardial Infarction Circulation, September 1, 1995; 92(5): 1133 - 1140. [Abstract] [Full Text]
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D. Pratico and G. A. FitzGerald Testosterone and Thromboxane : Of Muscles, Mice, and Men Circulation, June 1, 1995; 91(11): 2694 - 2698. [Full Text]
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V. Vaccarino, H. M. Krumholz, L. F. Berkman, and R. I. Horwitz Sex Differences in Mortality After Myocardial Infarction : Is There Evidence for an Increased Risk for Women? Circulation, March 15, 1995; 91(6): 1861 - 1871. [Abstract] [Full Text]
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R. C. Hendel, M. H. Chen, G. J. L'Italien, J. B. Newell, S. D. Paul, K. A. Eagle, and J. A. Leppo Sex Differences in Perioperative and Long-term Cardiac Event–Free Survival in Vascular Surgery Patients : An Analysis of Clinical and Scintigraphic Variables Circulation, February 15, 1995; 91(4): 1044 - 1051. [Abstract] [Full Text]
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P Wilkinson, K Laji, K Ranjadayalan, L Parsons, and A D Timmis Acute myocardial infarction in women: survival analysis in first six months BMJ, September 3, 1994; 309(6954): 566 - 569. [Abstract] [Full Text]
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F. E. Kuhn and C. E. Rackley Coronary Artery Disease in Women: Risk Factors, Evaluation, Treatment, and Prevention Arch Intern Med, December 13, 1993; 153(23): 2626 - 2636. [Abstract] [PDF]
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N. K. Wenger, L. Speroff, and B. Packard Cardiovascular Health and Disease in Women N. Engl. J. Med., July 22, 1993; 329(4): 247 - 256. [Full Text]
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P. R. Pagley, J. Yarzebski, R. Goldberg, Z. Chen, D. Chiriboga, P. Dalen, J. Gurwitz, J. S. Alpert, and J. M. Gore Gender Differences in the Treatment of Patients With Acute Myocardial Infarction: A Multihospital, Community-Based Perspective Arch Intern Med, March 8, 1993; 153(5): 625 - 629. [Abstract] [PDF]
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I. S. Udvarhelyi, C. Gatsonis, A. M. Epstein, C. L. Pashos, J. P. Newhouse, and B. J. McNeil Acute Myocardial Infarction in the Medicare Population: Process of Care and Clinical Outcomes JAMA, November 11, 1992; 268(18): 2530 - 2536. [Abstract] [PDF]
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S. B. Eysmann and P. S. Douglas Reperfusion and Revascularization Strategies for Coronary Artery Disease in Women JAMA, October 14, 1992; 268(14): 1903 - 1907. [Abstract] [PDF]
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H. M. Krumholz, P. S. Douglas, M. S. Lauer, and R. C. Pasternak Selection of Patients for Coronary Angiography and Coronary Revascularization Early after Myocardial Infarction: Is There Evidence for a Gender Bias? Ann Intern Med, May 15, 1992; 116(10): 785 - 790. [Abstract] [PDF]
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W. K. Laskey Gender Differences in the Management of Coronary Artery Disease: Bias or Good Clinical Judgment? Ann Intern Med, May 15, 1992; 116(10): 869 - 871. [Abstract] [PDF]
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C. Maynard, P. E. Litwin, J. S. Martin, and W. D. Weaver Gender Differences in the Treatment and Outcome of Acute Myocardial Infarction: Results From the Myocardial Infarction Triage and Intervention Registry Arch Intern Med, May 1, 1992; 152(5): 972 - 976. [Abstract] [PDF]
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