Gender Differences in Hospital Mortality and Use of Percutaneous Coronary Intervention in Acute Myocardial Infarction

Abstract

Background-Women with acute myocardial infarction have a higher hospital mortality rate than men. This difference has been ascribed to their older age, more frequent comorbidities, and less frequent use of revascularization. The aim of this study is to assess these factors in relation to excess mortality in women. Methods and Results-All hospital admissions in France with a discharge diagnosis of acute myocardial infarction were extracted from the national payment database. Logistic regression on mortality was performed for age, comorbidities, and coronary interventions. Nonparametric microsimulation models estimated the percutaneous coronary intervention and mortality rates that women would experience if they were "treated like men." Data were analyzed from 74 389 patients hospitalized with acute myocardial infarction, 30.0% of whom were women. Women were older (75 versus 63 years of age; PϽ0.001) and had a higher rate of hospital mortality (14.8% versus 6.1%; PϽ0.0001) than men. Percutaneous coronary interventions were more frequent in men (7.4% versus 4.8%; 24.4% versus 14.2% with stent; PϽ0.001). Mortality adjusted for age and comorbidities was higher in women (PϽ0.001), with an excess adjusted absolute mortality of 1.95%. Simulation models related 0.46% of this excess to reduced use of procedures. Survival benefit related to percutaneous coronary intervention was lower among women. Conclusions-The difference in mortality rate between men and women with acute myocardial infarction is due largely to the different age structure of these populations. However, age-adjusted hospital mortality was higher for women and was associated with a lower rate of percutaneous coronary intervention. Simulations suggest that women would derive benefit from more frequent use of percutaneous coronary intervention, although these procedures appear less protective in women than in men.

Spatial disparities in hospital performance

“…Females are more likely to die than males. This is consistent with care being more protective for males than for females possibly because of biological differences like the smaller target vessel size and the more important vessel tortuosity of females (Milcent et al, 2007). Also, the propensity to die increases with age.…”

Gender Differences in In-Hospital Mortality Rates among Hispanic Patients with Acute Myocardial Infarction

“…Furthermore, our study shows that the older the patient was, the higher the odds of dying in the hospital. These results are in concordance with several other studies, which conclude that females with myocardial infarction have higher in-hospital mortality compared to men [5][6][7][8][9][10]. Also similar to other studies, women in this sample were older and smoked less than men [10].…”

Sex Differences in Health and Survival

“…Several studies have indicated that shortand long-term post-MI (Koek et al 2006;Milcent et al 2007) and post-stroke mortality is higher in women than in men (Appelros et al 2009;Lewsey et al 2009;Appelros et al 2010;Andersen et al 2011). Some studies found that the female disadvantage in post-stroke survival was limited to younger ages (Vaccarino et al 1998(Vaccarino et al , 1999(Vaccarino et al , 2001Nielsen et al 2014), while others found that rates of post-MI and post-stroke survival did not differ significantly by gender after the baseline and clinical characteristics were taken into account (Galatius et al 1996;Herman et al 1997;MacIntyre et al 2001;Di Carlo et al 2003;Isaksson et al 2011;Olsen et al 2012).…”