Mortality after acute myocardial infarction in Chile: Is still different for women than men?

Mortality after acute myocardial infraction in Chile: is still different for women than men?

 Introduction: Previous studies suggested that women with acute myocardial infarction (AMI)
have higher mortality rates than men. Many strategies have been implemented to reduce this risk difference.
Aim: To evaluate the influence of gender on the long term mortality of Chilean patients with acute myocardial infarction (AMI).
Methods: 5232 patients with AMI were admitted from 2001 to 2004 in 21 hospitals that participated in the Chilean National Registry of Myocardial Infarction (GEMI).The proportion of women was 27%. Vital status was ascertained by a review of the National Death Registry at the Chilean Department of Statistics from 2001 to 2005. In-hospital treatment was compared between women and men using logistic regression adjusted by age. Survival analysis were done to estimate the risk of mortality by gender. Weibull regression analysis was used to estimate the risk adjusted for age, diabetes, hypertension, previous AMI and in hospital treatment. The results are expressed as Hazard Ratios (HR) and their 95% CI.
Results: Women were older (67 vs 60 years, p<0.0001), had a higher proportion of diabetes (35 vs 21%, p<0.0001) and hypertension (33 vs 19%, p<0.0001) than men. During hospitalization women received less often reperfusion therapies (OR=0.82, 0.70-0.86) and pharmacological therapy (0R=0.78, 0.65-0.93). Long term mortality was higher in women (Crude HR= 2.03, (1.78 - 2.31)) and remained higher in the multivariate analysis (HR= 1.31, (1.15 - 1.50)).
Conclusions:  Women with AMI had higher mortality in a five year follow-up than men. This difference was not explained by a higher prevalence of unfavourable basal conditions. Further studies must explore psychosocial factors that may also be involved to explain gender differences in mortality.