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Article
Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality
Quantitative Health Sciences Publications and Presentations
  • John G. Canto, University of Alabama
  • William J. Rogers, University of Alabama
  • Robert J. Goldberg, University of Massachusetts Medical School
  • Eric D. Peterson, Duke University
  • Nanette K. Wenger, Emory School of Medicine
  • Viola Vaccarino, Emory University
  • Catarina I. Kiefe, University of Massachusetts Medical School
  • Paul D. Frederick, University of Washington
  • George Sopko, National Heart, Lung, and Blood Institute
  • Zhi-Jie Zheng, Centers for Disease Control
UMMS Affiliation
Department of Quantitative Health Sciences; Meyers Primary Care Institute
Date
2-22-2012
Document Type
Article
Medical Subject Headings
Age Factors; Aged; Aged, 80 and over; Chest Pain; Female; Hospital Mortality; Hospitalization; Humans; Male; Middle Aged; Myocardial Infarction; Registries; Sex Factors; United States
Abstract

CONTEXT: Women are generally older than men at hospitalization for myocardial infarction (MI) and also present less frequently with chest pain/discomfort. However, few studies have taken age into account when examining sex differences in clinical presentation and mortality.

OBJECTIVE: To examine the relationship between sex and symptom presentation and between sex, symptom presentation, and hospital mortality, before and after accounting for age in patients hospitalized with MI.

DESIGN, SETTING, AND PATIENTS: Observational study from the National Registry of Myocardial Infarction, 1994-2006, of 1,143,513 registry patients (481,581 women and 661,932 men).

MAIN OUTCOME MEASURES: We examined predictors of MI presentation without chest pain and the relationship between age, sex, and hospital mortality.

RESULTS: The proportion of MI patients who presented without chest pain was significantly higher for women than men (42.0% [95% CI, 41.8%-42.1%] vs 30.7% [95% CI, 30.6%-30.8%]; P < .001). There was a significant interaction between age and sex with chest pain at presentation, with a larger sex difference in younger than older patients, which became attenuated with advancing age. Multivariable adjusted age-specific odds ratios (ORs) for lack of chest pain for women (referent, men) were younger than 45 years, 1.30 (95% CI, 1.23-1.36); 45 to 54 years, 1.26 (95% CI, 1.22-1.30); 55 to 64 years, 1.24 (95% CI, 1.21-1.27); 65 to 74 years, 1.13 (95% CI, 1.11-1.15); and 75 years or older, 1.03 (95% CI, 1.02-1.04). Two-way interaction (sex and age) on MI presentation without chest pain was significant (P < .001). The in-hospital mortality rate was 14.6% for women and 10.3% for men. Younger women presenting without chest pain had greater hospital mortality than younger men without chest pain, and these sex differences decreased or even reversed with advancing age, with adjusted OR for age younger than 45 years, 1.18 (95% CI, 1.00-1.39); 45 to 54 years, 1.13 (95% CI, 1.02-1.26); 55 to 64 years, 1.02 (95% CI, 0.96-1.09); 65 to 74 years, 0.91 (95% CI, 0.88-0.95); and 75 years or older, 0.81 (95% CI, 0.79-0.83). The 3-way interaction (sex, age, and chest pain) on mortality was significant (P < .001).

CONCLUSION: In this registry of patients hospitalized with MI, women were more likely than men to present without chest pain and had higher mortality than men within the same age group, but sex differences in clinical presentation without chest pain and in mortality were attenuated with increasing age.

Comments

Citation: JAMA. 2012 Feb 22;307(8):813-22. doi:10.1001/jama.2012.199. Link to article on publisher's site

Related Resources
Link to Article in PubMed
Citation Information
John G. Canto, William J. Rogers, Robert J. Goldberg, Eric D. Peterson, et al.. "Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality" Vol. 307 Iss. 8 (2012) ISSN: 0098-7484 (Linking)
Available at: http://works.bepress.com/catarina_kiefe/204/