Short- and Long-Term Prognosis after Acute Myocardial Infarction in Chinese Men and Women

Most, but not all, studies in Western countries have indicated that women have a higher mortality than men after an acute myocardial infarction, but this has not been well documented in the developing world. The authors studied 601 male and 294 female myocardial infarction patients, aged 26-94 years, admitted to a city hospital in Beijing, China, between 1974 and 1986. A total of 745 (98.8%) of the cohort of 754 who survived past their initial hospitalization were followed up in 1988. Compared with their male counterparts, female myocardial infarction patients were older (63.4 vs. 58.1 years) and had a higher prevalence of tachycardia (heart rate, > or = 110 beats/minute), rales, New York Heart Association class III or IV, and heart block, but a lower prevalence of smoking and white collar occupation (all p < 0.01). The mortality within 28 days of their myocardial infarction was higher in women than in men, mainly in the group whose age was less than 60 years (20.4% vs. 7.1%, p < 0.001). The greater risk of short-term mortality in women persisted even after adjustment for age, history of stroke and hypertension, tachycardia on admission, anterior infarction, Killip class III or IV, and arrhythmia (relative odds = 1.74, 95% confidence interval 1.17-2.60). The 10-year total cumulative mortality in persons who survived the first 28 days following their myocardial infarction was 51.1% for women and 35.9% for men (log rank p = 0.002). After adjustment for age, this difference was not statistically significant (p = 0.3). Our results suggest that, in Beijing, women have a higher short-term mortality after myocardial infarction compared with men.