Mortality after myocardial infarction: impact of gender and smoking status

Grundtvig, Morten; Hagen, Terje P.; Amrud, Elin S.; Reikvam, Aasmund

doi:10.1007/s10654-011-9557-6

Cited by 16 publications

(8 citation statements)

References 34 publications

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“…Interestingly, risk ratios for female sex actually switched directions after adjustment in five of these studies. 31, 32, 36, 37, 40 In all five, female sex was significantly associated with increased mortality in unadjusted analyses but became protective after multivariate adjustment.…”

Section: Resultsmentioning

confidence: 92%

Sex Differences in Long-Term Mortality After Myocardial Infarction

et al. 2014

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Background Studies of sex differences in long-term mortality after acute myocardial infarction (AMI) have reported mixed results. A systematic review is needed to characterize what is known about sex differences in long-term outcomes and to define gaps in knowledge. Methods and Results We searched the Medline database from 1966 to December 2012 to identify all studies that provided sex-based comparisons of mortality after AMI. Only studies with at least five years of follow-up were reviewed. Of the 1,877 identified abstracts, 52 studies met inclusion criteria, of which 39 were included in this review. Most studies included less than one-third women. There was significant heterogeneity across studies in patient populations, methodology, and risk adjustment, which produced substantial variability in risk estimates. In general, most studies reported higher unadjusted mortality for women compared with men at both 5 and 10 years after AMI; however, many of the differences in mortality became attenuated after adjustment for age. Multivariable models varied between studies; however, most reported a further reduction in sex differences after adjustment for covariates other than age. Few studies examined sex-by-age interactions; however several studies reported interactions between sex and treatment, whereby women have similar mortality risk as men after revascularization. Conclusions Sex differences in long-term mortality after AMI are largely explained by differences in age, comorbidities, and treatment utilization between women and men. Future research should aim to clarify how these differences in risk factors and presentation contribute to the sex gap in mortality.

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Section: Resultsmentioning

confidence: 92%

Sex Differences in Long-Term Mortality After Myocardial Infarction

et al. 2014

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“…Although we employed a comprehensive set of variables for risk adjustment, including variables measuring 15 comorbidities, we cannot rule out the possible impact of selection effects for PCI. For instance, there are no data available on smoking behaviour, a well‐documented risk factor for AMI (Grundtvig et al , ). The minor indirect effect of SES on mortality could therefore be overestimated.…”

Section: Discussionmentioning

confidence: 99%

Socio‐economic Inequality in the Use of Procedures and Mortality Among AMI Patients: Quantifying the Effects Along Different Paths

et al. 2015

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It is not known whether inequality in access to cardiac procedures translates into inequality in mortality. In this paper, we use a path analysis model to quantify both the direct effect of socio-economic status on mortality and the indirect effect of socio-economic status on mortality as mediated by the provision of cardiac procedures. The study links microdata from the Finnish and Norwegian national patient registers describing treatment episodes with data from prescription registers, causes-of-death registers and registers covering education and income. We show that socio-economic variables affect access to percutaneous coronary intervention in both countries, but that these effects are only moderate and that the indirect effects of the socio-economic factors on mortality through access to percutaneous coronary intervention are minor. The direct effects of income and education on mortality are significantly larger. We conclude that the socio-economic gradient in the use of percutaneous coronary intervention adds to socio-economic differences in mortality to little or no extent.

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“…[14–17] These discrepancies in study findings are likely due to differences in study characteristics and covariate selection. Additionally, short and long-term studies available have been limited by small numbers of current smokers,[5, 8, 11, 13–15] minimal covariate adjustment,[8, 10–12, 14, 15] and specific inclusion criteria such as hospital survivors,[14] patients undergoing revascularization,[5, 8, 9, 13] or non-ST-elevation AMIs,[16] which may limit their generalizability to all patients. As a result, it is unclear whether the “smoker’s paradox” can be explained by other patient characteristics and whether this short-term phenomenon persists over the long-term.…”

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confidence: 99%

Smoking status and life expectancy after acute myocardial infarction in the elderly

Bucholz

Beckman

Kiefe

et al. 2015

Heart

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Objective Smokers have lower short-term mortality after acute myocardial infarction than non-smokers; however, little is known about the long-term effects of smoking on life expectancy after AMI. The study aimed to quantify the burden of smoking after AMI using life expectancy and years of life lost. Methods We analyzed data from the Cooperative Cardiovascular Project, a medical record study of 158,349 elderly Medicare patients with AMI and over 17 years of follow-up, to evaluate the age-specific association of smoking with life expectancy and years of life lost after AMI. Results Our sample included 23,447 (14.8%) current smokers. Current smokers had lower crude mortality up to 5 years, which was largely explained by their younger age at AMI. After adjustment other patient characteristics, smoking was associated with lower 30-day (HR 0.91, 95% confidence interval (CI) 0.87–0.94) but higher long-term mortality (17-year HR 1.19, 95% CI 1.17–1.20) after AMI. Overall, crude life expectancy estimates were lower for current smokers than non-smokers at all ages, which translated into sizeable numbers of life-years lost attributable to smoking. As age at AMI increased, the magnitude of life-years lost due to smoking decreased. After full risk adjustment, the differences in life expectancy between current smokers and non-smokers persisted at all ages. Conclusions Current smoking is associated with lower life expectancy and large numbers of life-years lost after AMI. Our findings lend additional support to smoking cessation efforts after AMI.

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Mortality after myocardial infarction: impact of gender and smoking status

Cited by 16 publications

References 34 publications

Sex Differences in Long-Term Mortality After Myocardial Infarction

Sex Differences in Long-Term Mortality After Myocardial Infarction

Socio‐economic Inequality in the Use of Procedures and Mortality Among AMI Patients: Quantifying the Effects Along Different Paths

Smoking status and life expectancy after acute myocardial infarction in the elderly

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