Sex differences in treatments,relative survival,and excess mortality following acute myocardial infarction: National cohort study using the SWEDEHEART registry

Background--this study assessed sex differences in treatments,all-cause mortality,relative survival,and excess mortality following acute myocardial infarction. methods and results--a population-based cohort of all hospitals providing acute myocardial infarction care in sweden (swedeheart [swedish web system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies]) from 2003 to 2013 was included in the analysis. excess mortality rate ratios (emrrs),adjusted for clinical characteristics and guideline-indicated treatments after matching by age,sex,and year to background mortality data,were estimated. although there were no sex differences in all-cause mortality adjusted for age,year of hospitalization,and comorbidities for st-segment-elevation myocardial infarction (stemi) and non-stemi at 1 year (mortality rate ratio: 1.01 [95% confidence interval (ci),0.96-1.05] and 0.97 [95% ci,0.95-0.99],respectively) and 5 years (mortality rate ratio: 1.03 [95% ci,0.99-1.07] and 0.97 [95% ci,0.95-0.99],respectively),excess mortality was higher among women compared with men for stemi and non-stemi at 1 year (emrr: 1.89 [95% ci,1.66-2.16] and 1.20 [95% ci,1.16-1.24],respectively) and 5 years (emrr: 1.60 [95% ci,1.48-1.72] and 1.26 [95% ci,1.21-1.32],respectively). after further adjustment for the use of guideline-indicated treatments,excess mortality among women with non-stemi was not significant at 1 year (emrr: 1.01 [95% ci,0.97-1.04]) and slightly higher at 5 years (emrr: 1.07 [95% ci,1.02-1.12]). for stemi,adjustment for treatments attenuated the excess mortality for women at 1 year (emrr: 1.43 [95% ci,1.26-1.62]) and 5 years (emrr: 1.31 [95% ci,1.19-1.43]). conclusions--women with acute myocardial infarction did not have statistically different all-cause mortality,but had higher excess mortality compared with men that was attenuated after adjustment for the use of guideline-indicated treatments. this suggests that improved adherence to guideline recommendations for the treatment of acute myocardial infarction may reduce premature cardiovascular death among women. © 2017 the authors.