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European Society of
Cardiology Congress 2017
26–30 AUGUST 2017 • BARCELONA, SPAIN
ESC 2017: The Gender Gap in Death fromAcuteMyocardial Infarction
Is Closing, Particularly inWomen Younger Than Age 60
The gender gap in death from acute myocardial infarction has been closing over the past two decades, particularly in
women younger than 60 years of age. The retrospective analysis included over 50,000 patients and found that overall
in-hospital mortality for patients with acute myocardial infarction halved over the 20-year period. It was presented at
the 2017 European Society of Cardiology (ESC) Congress, from August 26–30.
D
ragana Radovanovic, MD, of the AMIS
Plus Data Centre, University of Zurich,
Switzerland, explained that research
in the 1990s “showed that younger women
with acute myocardial infarction had a
higher mortality than men of similar age.
Little is known about whether this gender
difference has persisted over the years.”
Dr. Radovanovic and colleagues set out
to assess changes in in-hospital mortality
of men and women with acute myocar-
dial infarction over a 20-year period. The
adjusted in-hospital mortality rate was cal-
culated logistic regression analysis.
Data were collected from 1997 through 2016
in the nationwide AcuteMyocardial Infarction
in Switzerland registry (AMIS Plus). The study
included 51,725 patients with acute myocar-
dial infarction from83 Swiss hospitals. Among
them, 30,398 (59%) presented with ST-seg-
ment elevation myocardial infarction (STEMI)
and 21,327 (41%) with non-ST-segment eleva-
tion myocardial infarction (NSTEMI).
The study population was 73% male (mean
age 63.9 ± 12.8 years) and 27% female (mean
age 71.7 ± 12.5 years). Womenwereolder than
men in both the STEMI (71.3 ± 12.7 vs 62.8 ±
12.8 years, P < .001) and the NSTEMI group
(72.2 ± 12.2 vs 65.6 ± 12.6 years, P < .001).
Mean age did not change for either gender
during the observation period.
The researchers found a decrease in crude
in-hospital mortality from 1997 to 2016. In
STEMI patients, in-hospital mortality dropped
significantly, from 9.8% to 5.5% in men and
from 18.3% to 6.9% in women (P < .001 for
both). In NSTEMI patients, it fell from 7.1%
to 2.1% in men and 11.0% to 3.6% in women
(P < .001 for both).
Dr. Radovanovic said that in-hospital mor-
tality of patients with acute myocardial
infarction fell by at least half over the 20-year
period. Differences in death rates between
men and women also dropped. Previous
research showed that younger women with
acute myocardial infarction experienced
higher mortality than men of similar age;
therefore, Dr. Radovanovic and coinvestiga-
tors analyzedmortality separately in patients
younger than 60 years of age.
In women, they found 6% and 13%
decreases in mortality with each sub-
sequent admission year for STEMI and
NSTEMI, respectively. No significant
decreases were observed in men younger
than 60 years of age.
Mortality per year decreased dramatically
in NSTEMI women (odds ratio 0.87, 95%
confidence interval 0.80–0.94, P < .001) but
was not significant in men (odds ratio 0.98,
95% confidence interval 0.94–1.03). The
interaction between gender and admission
year was significant at P = .006.
Dr. Radovanovic noted that women still
experience higher in-hospital mortality from
acute myocardial infarction than men, prob-
ably because they are on average 8 years
older when they suffer a heart attack, and
they harbor more cardiovascular risk fac-
tors and comorbidities.
According to Dr. Radovanovic, although
in-hospital mortality continues to be higher
in women than men, overall age-adjusted
mortality has decreased more prominently
in women than men, particularly those
younger than 60 years of age. The nar-
rowing of the gender gap in mortality over
the past 20 years may be due to increasing
use of percutaneous coronary intervention
(PCI) in women. The use of reperfusion
to open blocked arteries, especially PCI,
increased in all patients admitted for acute
myocardial infarction. In STEMI patients,
use of PCI increased from 60% to 93% in
men and 45% to 90% in women.
PracticeUpdate Editorial Team
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