Gender Difference in Determinants of Short-Term Survival of Patients with Acute Myocardial Infarction in Isfahan, Iran

Abstract

Background: Compared to men, women suffer from acute myocardial infarction (AMI) at higher age. In addition, hypertension, dyslipidemia, diabetes mellitus, and in-hospital mortality are more frequent in women. This study aimed to determine gender-based differences in predictive factors of short-term survival in patients with acute myocardial infarction. Methods: In a cohort study based on hospital records during 1999-2008, all patients with AMI admitted to all public and private hospitals in Isfahan and Najaf Abad (center of Iran) were investigated. To determine predictive factors of short-term (28-day) survival, univariate and multivariate Cox regression analyses were used. Survival rate of patients was calculated using Kaplan-Meier and log rank tests. Findings: Overall, 12815 patients with AMI were included (72.6% male). The adjusted relative risk (RR) of death increased with age. In patients over 80 years of age, RR was 12.7 [95% confidence interval (CI): 5.1-31.3] in men and 8.8 (95% CI: 1.2-63.1) in women. In both genders, RR of anterior wall infarction was greater than inferior wall infarction [3.0 (95% CI: 1.8-5.1) vs. 1.7 (95% CI: 1.0-3.0) in men and 2.2 (95% CI: 1.2-4.0) vs. 1.6 (95% CI: 0.8-2.9) in women]. While survival rate increased in both genders during the study period, this improvement was more apparent in women. Conclusion: Increasing trend of survival rate following an AMI in both genders warrants continuous medical care and public health promotion activities. Physicians will therefore be encouraged to provide more efficient care for patients who are at higher risk of mortality. Keywords: Acute myocardial infarction, Short-term survival, Gender-based differences, Cox regression, Iran