To investigate the association between gender, symptom presentation, and hospital mortality, John G. Canto, M.D., M.S.P.H., from the Watson Clinic and Lakeland Regional Medical Center in Florida, and colleagues conducted an observational study of 1,143,513 registry patients (481,581 women) from the National Registry of Myocardial Infarction, 1994 to 2006.
The researchers found that significantly more female than male patients presented without chest pain (42.0 versus 30.7 percent). Sex-specific differences in MI presentation without chest pain declined with advancing age (age-specific multivariable adjusted odds ratios [ORs] for women compared to men: younger than 45 years, 1.30; 45 to 54 years, 1.26; 55 to 64 years, 1.24; 65 to 74 years, 1.13; and 75 years or older, 1.03). The in-hospital mortality rate was 14.6 percent for women and 10.3 percent for men. Greater hospital mortality was seen for younger women than younger men, presenting without chest pain, with the differences decreasing and then reversing with advancing age (adjusted ORs for age younger than 45 years, 1.18; 45 to 54 years, 1.13; 55 to 64 years, 1.02; 65 to 74 years, 0.91; and 75 years or older, 0.81).
"Sex differences in clinical presentation without chest pain and in mortality were attenuated with increasing age," the authors write.
Several authors disclosed financial ties to pharmaceutical and medical device companies. The National Registry of Myocardial Infarction was funded by Genentech.
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