Sex-specific trends in 4-year survival in 37 276 men and women with acute myocardial infarction before the age of 55 years in Sweden, 1987–2006: a register-based cohort study

Abstract

ObjectiveTo examine sex-specific trends in 4-year mortality among young patients with first acute myocardial infarction (AMI), 1987–2006.DesignProspective cohort study.SettingSweden.ParticipantsWe identified 37 276 cases (19.4% women; age, 25–54 years) from the Swedish Inpatient Register, 1987–2006, who had survived 28 days after an AMI.Outcome measures4-year mortality from all causes and standard mortality ratio (SMR).ResultsFrom the first to last 5-year period, the absolute excess risk decreased from 1.38 to 0.50 and 1.53 to 0.59 per 100 person-years among men aged 25–44 and 45–54 years, respectively. Corresponding figures for women were a decrease from 2.26 to 1.17 and from 1.93 to 1.45 per 100 person-years, respectively. Trends for women were non-linear, decreasing to the same extent as those for men until the third period, then increasing. For the last 5-year period, the standardised mortality ratio for young survivors of AMI compared with the general population was 4.34 (95% CI 3.04 to 5.87) and 2.43 (95% CI 2.12 to 2.76) for men aged 25–44 and 45–54 years, respectively, and 13.53 (95% CI 8.36 to 19.93) and 6.42 (95% CI 5.24 to 7.73) for women, respectively. Deaths not associated with cardiovascular causes increased from 21.5% to 44.6% in men and 41.5% to 65.9% in women.ConclusionsYoung male survivors of AMI have low absolute long-term mortality rates, but these rates remain twofold to fourfold that of the general population. After favourable development until 2001, women now have higher absolute mortality than men and a 6-fold to 14-fold risk of death compared with women in the general population.

Risk factors, prognosis, and secondary prevention of myocardial infarction in young adults in Poland

“…At the same time, there is a great risk of cardiovascular rehospitalisation, especially if the patient continues to smoke [32]. The results of studies by Nielsen et al [33] should therefore come as no surprise, wherein long-term mortality in young patients after MI, albeit low, remains two to four times higher than in the general male population, and even higher in women. Maroszyńska-Dmoch and Wożakowska-Kapłon [34] noted 7.75% mortality during long-term follow-up in young patients with acute coronary syndrome.…”

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).…”

Long-Term Survival Among Patients With Myocardial Infarction Before Age 50 Compared With the General Population

“…3 It showed that among 30-day survivors, the MRRs were 2.6 for men and 5.6 for women aged 30 to 54 years after 4 years compared with people of equivalent age in the general population. 2,3 The other study was a Swedish population-based 4-year cohort study of MI patients aged 25 to 55 years diagnosed during the 20-year period from 1987 to 2006. 2 Here, young 28-day male survivors of acute MI before age 50 had low absolute long-term mortality rates (between 0.5 and 0.59 per 100 person-years for men and between 1.2 and 1.5 per 100 person-years for women), although they remained 2-to 4-fold higher than in the general population.…”

“…2,3 The other study was a Swedish population-based 4-year cohort study of MI patients aged 25 to 55 years diagnosed during the 20-year period from 1987 to 2006. 2 Here, young 28-day male survivors of acute MI before age 50 had low absolute long-term mortality rates (between 0.5 and 0.59 per 100 person-years for men and between 1.2 and 1.5 per 100 person-years for women), although they remained 2-to 4-fold higher than in the general population. 2 Despite overlapping confidence intervals, we note that the higher 1-to 10-year mortality among non-STEMI patients is consistent with previous reports and is …”

“…Until now, only 2 other studies have made this comparison. 2,3 The first was a UK cohort study, including 59 308 MI patients aged 30 to 54 years who were diagnosed during 2004-2010. 3 It showed that among 30-day survivors, the MRRs were 2.6 for men and 5.6 for women aged 30 to 54 years after 4 years compared with people of equivalent age in the general population.…”