What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (AMI) (n=3840). Intervention: Female sex vs. Male sex. Primary outcome: 5-year all-cause mortality (HR 1.54, 95% CI 1.28-1.85, p=<0.0001).

October 20, 2017PLoS ONEOpen Access

Sex differences in long-term mortality among acute myocardial infarction patients: Results from the ISAR-RISK and ART studies

Q: What are the key findings of this study?

While females in the overall cohort had significantly higher 5-year mortality than males (HR 1.54), a matched cohort analysis revealed no significant difference over 5 years (HR 1.14), though females experienced higher mortality during the first year (HR 1.61).

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Key result

While females in the overall cohort had significantly higher 5-year mortality than males (HR 1.54), a matched cohort analysis revealed no significant difference over 5 years (HR 1.14), though females experienced higher mortality during the first year (HR 1.61).

Why the study?

Does female sex increase long-term mortality in acute myocardial infarction survivors compared to matched males?

Population

3,840 consecutive acute myocardial infarction survivors, enrolled between 1996 and 2005. 994 females and…

Comparison

Female sex (observational exposure) vs Male sex (matched 1:1 for age, previous AMI…

Design

Cohort

Follow-up

5 years

Authors

RURomy UbrichKlinikum rechts der Isar PBPetra BarthelElectrophysiology BHBernhard HallerUniversity of Bern

Discussion

Member takes

Implication

Baseline matching eliminates long-term sex mortality differences after AMI; leaves open early excess risk in females.

Study Design

Type

Cohort (n=3,840)

Multicenter

Yes

Structured PICO

Does female sex increase long-term mortality in acute myocardial infarction survivors compared to matched males?

Population

3,840 survivors of acute myocardial infarction (25.9% female) followed for 5 years to assess sex differences in long-term mortality, from which a propensity-matched cohort of 1,604 patients was derived.

Exposure

Female sex (observational exposure)

Comparator

Male sex (matched 1:1 for age, previous AMI, sinus rhythm, hypertension, diabetes mellitus, smoking status, left ventricular ejection fraction (LVEF), and revascularization therapy)

Outcome

5-year all-cause mortalityhard clinical

Main Result

Hazard Ratio: 1.54 (95% CI 1.28–1.85)

Absolute Event Rate: 17.6% vs 11.8%

p-value: p=<0.0001

Limitations

No detailed information was collected regarding symptom-to-balloon time or coronary pathology such as endothelial dysfunction.
Unable to include data on pre-AMI lifestyles (except smoking), socioeconomic aspects, family support, or prevalence of depression.
Impossible to find a male match for nearly one-fifth of the female patients, who were older and sicker, limiting generalizability.
Retrospective analysis of prospectively-collected data.
Time to PCI or thrombolysis not routinely collected
Social status, marital status, quality of life, and depressive symptoms not assessed
Oldest and sickest females were excluded from the matched cohort due to strict matching process

Cite This Study

Ubrich et al. (2017) conducted a cohort in Acute myocardial infarction (AMI) (n=3,840). Female sex vs. Male sex was evaluated on 5-year all-cause mortality (HR 1.54, 95% CI 1.28-1.85, p=<0.0001). While females in the overall cohort had significantly higher 5-year mortality than males (HR 1.54), a matched cohort analysis revealed no significant difference over 5 years (HR 1.14), though females experienced higher mortality during the first year (HR 1.61).

synapsesocial.com/papers/6a20f0952e0c95b4d1ecb85e https://doi.org/10.1371/journal.pone.0186783

Topics

Women and heart disease

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Sex differences in long-term mortality among acute myocardial infarction patients: Results from the ISAR-RISK and ART studies

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Sex differences in long-term mortality among acute myocardial infarction patients: Results from the ISAR-RISK and ART studies

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

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