Age and sex related outcomes in Acute myocardial infarction


A study comparing STEMI and NSTEMI rates, management patterns, and in-hospital morbidity and mortality in men and women stratified into 4 age groups (<45, 45 to 64, 65 to 84, and ≥85 years of age).


A total of 6,720,639 weighted hospitalizations for MI (79.8% NSTEMI, and 20.2% STEMI) were included. 


The incidence rate of hospitalizations for MI was lower in women than men across all age groups. 


Women were less likely than men to undergo coronary angiography, revascularization, or to use circulatory-support devices. 



These differences were consistent across all age groups. 



Compared with men, women have lower incidence of MI and less likelihood of undergoing invasive treatment regardless of age. 



The negative impact of female sex on most outcomes is  most pronounced in young and middle-aged women.



The incidence, management, and outcomes of myocardial infarction (MI), reveal a clear association between female sex with less likelihood of referral to invasive treatment and with worse outcomes.

Women or 1.65 times more likely than men to be re-hospitalized in the 12 months after a heart attack.: Rate of hospitalization for any cause 34.8% in women compared to 23% in men.


The ((Nationwide Inpatient Sample (NIS))) was used to derive patient relevant information, and is the largest publicly available all-payer claim database in the United States. 


Adult patients admitted with a principal diagnosis of MI (STEMI, NSTEMI) during the study’s period were identified.



The incidence of MI is higher in men than in women.


Women suffering with an MI have distinctive risk profile, symptoms, and often unusual pathophysiology compared with men.


Women are less likely to undergo coronary revascularization than men.


Young women have worse outcomes following STEMI and NSTEMI than men. 


Most studies showed higher morbidity and mortality of AMI in women than in men, while others report no difference in adjusted mortality rates.


In a meta-analysis of >68,000 patients with STEMI, female sex was associated with a 2-fold increase in in-hospital mortality, but that was attenuated by 50% after adjustment for baseline characteristics and disappeared during 1-year follow-up.


The incidence of AMI is higher in men than in women across all age groups. 

Patients with MI who are age ≥85 years were predominately women. 


Aggressive invasive management is less frequent in women than in men, regardless of age.


The negative differential impact of female sex on post-MI mortality and most major complications of AMI are inversely related to age.


Several studies have shown that, in NSTEMI, women are less likely than men to receive early angiography ± revascularization.


There is documentation of a clear association between female sex and less-invasive treatment of both STEMI and NSTEMI across all age groups. 


Reasons for this marked disparity: delayed or atypical presentation, worse outcomes of invasive strategy in women, and acceptance of treatment.


Whether a more aggressive management of MI in women would further improve their outcomes requires additional investigations.


Several studies have documented worse outcomes following AMI in young women. 


Women age 30 to 54 years had worse in-hospital mortality and longer hospitalizations than men.


Hispanic women age <65 years experience higher adjusted in-hospital mortality compared with younger white men.


In a study of 29,265 patients from the Netherlands showed that although 1-year post-MI mortality was higher in women than in men, 7.3% vs 5.6%,the relationship between sex and mortality was age dependent with a higher mortality in women ≤71 years, but lower mortality in older women compared with men.


In a study of about 7 million weighted hospitalizations for AMI: younger women do generally worse, but older women do better than their men counterparts. 


The higher risk-adjusted in-hospital mortality in women in this study was confined to those age <65 following NSTEMI, and those age <85 following STEMI. 


Vascular complications and major bleeding in women were attenuated with increasing age. 


Neurologic and renal outcomes did exhibit an opposite trend with increasing age.


Age is a key determinant of outcomes in women.


In a large contemporary US cohort, women have lower incidence of acute MI and less likelihood of undergoing invasive treatment compared with men, regardless of their age.


Post-MI outcomes are age specific, and the negative impact of female sex on most outcomes appears to be confined to young and middle-aged women.


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