No gender differences in prognosis and preventive treatment in patients with AMI without significant stenoses

Objective: To investigate possible gender differences in patients with acute myocardial infarction (AMI) and without significant stenoses on coronary angiography (CAG) regarding prognosis and use of secondary preventive medication.

Design: Nationwide register-based cohort study.

Patients: By compiling data from Danish registries, we identified 20,800 patients hospitalized with AMI during 2005–2007. We included the 834 women and 761 men without significant stenoses on CAG who were discharged and alive after 60 days.

Main outcome measures: All-cause mortality, recurrent AMI, and redeeming a prescription for a lipid-lowering drug, beta-blocker, clopidogrel, or aspirin within 60 days of discharge.

Results: During follow-up, 97 women and 60 men died, resulting in a crude female/male hazard ratio (HR) of 1.51 (95% CI 1.09–2.08). After adjustment for age, time-period, and comorbidity, the gender difference was attenuated (HR 1.22, 95% CI 0.86–1.72). AMI recurrence was experienced by 28 women and 29 men with a female/male HR 0.88 (95% CI 0.52–1.48). After multivariable adjustment results were similar (HR 0.84, 95% CI 0.50–1.43). More women than men redeemed a prescription for lipid-lowering drugs with no differences in other medication. In the adjusted models lipid-lowering drugs, beta-blockers, clopidogrel, and aspirin were all redeemed equally with odds ratio (OR) 1.25 (95% CI 0.99–1.59), OR 1.10 (95% CI 0.88–1.37), OR 1.09 (95% CI 0.88–1.34), and OR 1.13 (95% CI 0.90–1.42), respectively.

Conclusion: Our study shows that in a population of patients with a first admission for AMI and no significant stenoses on CAG, women share the same prospects as men regarding long-term prognosis and the extent of secondary preventive medical treatment.