Sex-Related Differences on Mortality in Patients Aged 80 Years or Older With Acute Myocardial Infarction: There Is Still a Gap

Introduction: Sex-related differences on cardiovascular mortality in patients with acute coronary syndrome have been debated for decades. Although the gap between the two sexes has begun to close, women still have higher all-cause mortality. However, there is little data with respect to elderly women, particularly for those over 80 years. Therefore, we sought to determine all-cause mortality of elderly women with acute myocardial infarction and to compare it to men. Materials and Method: This retrospective study evaluated patients 80 years or older who were admitted to the cardiology clinic due to acute myocardial infarction between May 2015 and November 2017. The primary outcomes of the study were in-hospital, 30-day, and longterm all-cause mortality. Results: Two hundred twenty patients (126 women and 94 men) were included in the final analysis. Median follow-up was eight months. Long-term all-cause mortality of women was significantly higher compared to men [n=52 (41.3%) vs. n=26 (27.7%), respectively; p=0.03]. There was no significant sex difference for both in-hospital and 30-day mortality, although women had more events. Kaplan-Meier analysis revealed lower cumulative survival for women (log-rank: p=0.02), and Cox regression analysis found that female sex was as an independent risk factor for mortality [hazard ratio=1.7 (95% confidence interval=1.06-2.72); p=0.02]. Conclusion: Sex-related differences on mortality continue to be a critical issue, even for elderly patients with acute myocardial infarction. Since women have significantly higher longterm all-cause mortality, they should strictly be treated according to the guidelines and every effort should be made for risk reduction with close follow-up.