Gender differences in all-cause, cardiovascular and cancer mortality during long-term follow-up after acute myocardial infarction; a prospective cohort study

Abstract

Background: Gender differences in short-term mortality in acute myocardial infarction (AMI) have been studied extensively, whereas gender differences in long-term mortality and cause of death largely remain unknown. The aim of this study was to assess the long-term risk of all-cause, cardiovascular and cancer death after AMI in women compared to men. Methods: Consecutive AMI patients were enrolled in a prospective registry between 2005 and 2011. Date and cause of death were obtained by linkage with the Norwegian Cause of Death Registry, with censoring date 31 December 2012. AMI patients with ST-segment elevation (STEMI, n = 5159) and without (NSTEMI, n = 4899) were analysed separately. Results: The 5-years all-cause mortality rates in STEMI were 29% in women vs. 17% in men, and 42% vs. 29% in NSTEMI, respectively. After adjustment for age and other confounders, women with STEMI had similar (HR 1.13 [95% CI: 0.98-1.32]) and women with NSTEMI lower (HR 0.82 [95% CI: 0.73-0.92]) risk of long-term all-cause mortality compared to men. Competing-risks analysis showed no significant gender differences in age-adjusted risk of cardiovascular death nor of cancer death. In both genders, the annual risk of cardiovascular death was low after 1 year, but exceeded annual risk of cancer death throughout follow-up. Conclusion: During long-term follow-up, women with STEMI had similar and women with NSTEMI lower adjusted risk of all-cause mortality compared to men. Age-adjusted risk of death due to cardiovascular disease was similar in both genders and higher than risk of death due to cancer throughout the follow-up period.