Comparison of Gender-specific Mortality in Patients < 70 Years versus ≥ 70 Years Old with Acute Myocardial Infarction

A considerable body of literature has demonstrated gender discrepancies in overall mortality after acute myocardial infarction (AMI). This study assessed age-stratified mortality rates among men and women undergoing coronary angiography for AMI to determine whether gender discrepancies are age specific. The retrospective observational study included 2677 consecutive patients at a single tertiary care center who presented with chest pain, and subsequently were found to have electrocardiographic changes and biomarker changes consistent with an MI, and underwent angiography before revascularization therapy. Patients were divided by gender and by age; > or < 70 years old. Consistent with prior data, women had MIs at older ages within both of these age groups (> 70 years old age group: women 77.1 ± 5.5 years vs. men 75.4 ± 4.6 years old; p < 0.001, < 70 years old age group: women 60.4 ± 8.2 years old vs. men 56.4 ± 8.5 years old; p < 0.001). In both age groups, women had a statistically significant increased number of medical problems, including diabetes and hypertension, although men in both age groups had a statistically significant increased incidence of cigarette smoking and higher incidence of prior myocardial infarctions. Overall MI characteristics, including location of event, evidence of collateral circulation on angiography, and multi-vessel disease, demonstrated no difference between genders in either age group. Overall treatment, including angioplasty, use of stents, use of thrombolysis, and coronary artery bypass surgery rates, were not different between the genders in either age group. The primary outcome, overall survival to hospital discharge, was significantly different between men and women in the > 70-year-old age group (women 11.7% vs. men 5.0%), although in the < 70-year-old age group, no difference was found (women 5.7% vs. men 4.9%). In a multivariate logistic regression model that included past medical history, risk factors, MI characteristics, and treatment characteristics, female age was positively predictive of in-hospital mortality for patients > 70 years of age (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.05–3.00), whereas in patients < 70 years of age, female gender was not associated with increased in-hospital mortality (OR 1.09, 95% CI 0.53–2.24).