Gender differences in the decrease of in-hospital mortality in patients with acute myocardial infarction during the last 20 years in Switzerland

Dragana Radovanovic, Burkhardt Seifert, Marco Roffi, Philip Urban, Hans Rickli, Giovanni Pedrazzini, Paul Erne, Dragana Radovanovic, Burkhardt Seifert, Marco Roffi, Philip Urban, Hans Rickli, Giovanni Pedrazzini, Paul Erne

Abstract

Objective: To assess temporal trends of in-hospital mortality in patients with acute myocardial infarction (AMI) enrolled in the Swiss nationwide registry (AMIS Plus) over the last 20 years with regard to gender, age and in-hospital treatment.

Methods: All patients with AMI from 1997 to 2016 were stratified according to ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI), and gender using logistic regression analyses.

Results: Among 51 725 patients, 30 398 (59%) had STEMI and 21 327 (41%) had NSTEMI; 73% were men (63.9±12.8 years) and 27% were women (71.7±12.5 years). Over 20 years, crude in-hospital STEMI mortality decreased from 9.8% to 5.5% in men and from 18.3% to 6.9% in women. In patients with NSTEMI, it decreased from 7.1% to 2.1% in men and from 11.0% to 3.6% in women. After adjustment for age, mortality decreased per additional admission year by 3% in men with STEMI (OR 0.97, 95% CI 0.96 to 0.98, P<0.001), by 5% in women with STEMI (OR 0.95, 95% CI 0.93 to 0.96, P<0.001), by 6% in men with NSTEMI (OR 0.94, 95% CI 0.93 to 0.96, P<0.001) and by 5% in women with NSTEMI (OR 0.95, 95% CI 0.93 to 0.97, P<0.001). In patients <60 years, a decrease in mortality was seen in women with STEMI (OR 0.94, 95% CI 0.90 to 0.99, P=0.025) and NSTEMI (OR 0.87, 95% CI 0.80 to 0.94, P<0.001) but not in men with STEMI (OR 1.01, 95% CI 0.98 to 1.04, P=0.46) and NSTEMI (OR 0.98, 95% CI 0.94 to 1.03, P=0.41). The mortality decrease in patients with AMI was closely associated with the increase in reperfusion therapy.

Conclusion: From 1997 to 2016, in-hospital mortality of patients with AMI in Switzerland has halved and was more pronounced in women, particularly in the age category <60 years.

Trial registration number: NCT01305785; Results.

Keywords: NSTEMI; STEMI; coronary intervention (PCI); gender.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The predicted probability of in-hospital mortality in patients with AMI aged 66 years according to admission year and gender. STEMI, ST-segment elevation myocardial infarction; NSTEMI, non-ST-segment elevation myocardial infarction.
Figure 2
Figure 2
Crude in-hospital mortality of patients with STEMI according to admission year and gender from 1997 to 2016. STEMI, ST-segment elevation myocardial infarction.
Figure 3
Figure 3
Crude in-hospital mortality of patients with NSTEMI according to admission year and gender from 1997 to 2016. NSTEMI, non-ST-segment elevation myocardial infarction.

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