Sex differences in case fatality following a first acute myocardial infarction 1986-95

K. MacIntyre, S. Stewart, S. Capewell, J. Chalmers, J. Boyd, A. Finlayson, A. Redpath, J. Pell, C. Evans, H. Gilmour, J. J.V. McMurray

Research output: Contribution to journalReview articlepeer-review


Background: Evidence is conflicting regarding an independent effect of sex on prognosis after acute myocardial infarction (AMI). We examined short and long-term case fatality in all patients admitted to hospital with a first AMI in Scotland between 1986-1995 to determine whether sex-based differences in survival exist. We also analysed trends in case fatality in men and women over this period. Methods: We used the National Morbidity Record Database to carry out a Scottish wide, retrospective, cohort study of all 117,718 first AMI patients admitted to hospital between 1986 and 1995. Mortality to 10 years was calculated with multivariate modelling to adjust for factors known to influence survival. Results: 49155 women, who were on average seven years older than the 68563 men, were hospitalised with a first AMI between 1986 and 1995. In the short term, sex-based differences varied according to age, with younger women having higher rates of death than age matched men. Sex was not found to be an independent predictor of longer-term prognosis. Adjusted case fatality rates fell significantly between 1986-1995, by 46% in men and 27% in women. The sex disparity in declining short-term case fatality was most evident in younger age groups. Conclusions: Sex-based differences in survival after AMI were only present in the short term when younger women, but not older women had a higher case fatality than men. Short-term case fatality declined substantially between 1986 and 1995, more so in men and younger age groups. Further investigation and explanation of these disturbing findings are required.

Original languageEnglish
Issue numberSUPPL. 1
Publication statusPublished - 1 Jan 2000
Externally publishedYes


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