Life expectancy in women and men after STEMI: a comparison to a matched general population

Abstract Background/Introduction ST-elevation myocardial infarction (STEMI) is considered a risk factor for short- and long-term mortality. Further, studies indicate that female sex is associated with increased mortality among STEMI patients. Our aim was to assess the impact of female and male sex on short- and long-term excess mortality in comparison to matched general populations. Methods We identified all patients undergoing first-time percutaneous coronary intervention (PCI) who were treated with primary PCI (pPCI) for STEMI from 2003 to 2018 in the Western Denmark Heart Registry (covering approximately 3.3 million inhabitants). Each patient was matched in a 1:5 ratio by age and sex with individuals from the Western Denmark general population without prior myocardial infarction or coronary revascularization. To assess excess mortality after STEMI, we compared mortality in women and men to their matched general population using a stratified Cox proportional hazards model. Excess mortality was assessed in the periods from 0-30 days, 31-90 days, and 91 days – 4 years of follow-up. Results A total of 18,216 pPCI-treated STEMI patients were included, 4,833 (26.5%) women and 13,382 (73.5%) men. The matched general population cohort consisted of 91,075 individuals, 24,165 women and 66,910 men. Median age at STEMI diagnosis was 68 years (IQR 58-78) in women and 62 years (54-71) in men. Excess mortality was markedly higher in the first 30 days after STEMI with the relative risk being 35 times higher for both women (hazard ratio (HR) 34.63, 95% CI 26.11-45.95) and men (HR 35.18, 28.48-43.48) compared to their matched general populations. From 31-90 days, the excess mortality remained higher after STEMI for women (HR 3.58, 2.58-4.97) and men (HR 2.00, 1.58-2.55). However, in the 91 days - 4 years follow-up period there was only a marginal unadjusted 13% excess mortality in women (HR 1.13, 1.02-1.25) while an 8% lower mortality was observed in men (HR 0.92, 0.86-0.98; p for interaction<0.05). After adjusting for comorbidities in the 91 days - 4 years period, an excess mortality in women was no longer observed (HR 1.03, 0.93-1.14), while men with STEMI remained at lower risk than the general population (HR 0.87, 0.81-0.94). Conclusions In a large, contemporary STEMI cohort mortality within the first 30 days were 35 times higher in both women and men when compared to mortality in an age- and sex- matched general population. However, STEMI patients surviving the first 90 days were no longer at higher risk than their matched general population individuals; the latter most likely reflecting guideline-directed prophylactic interventions.Excess mortality in women with STEMIExcess mortality in men with STEMI