The Northern Sweden MONICA Myocardial Registry, Department of Research, Norrbotten County Council, Luleå, Sweden.
BMC Cardiovasc Disord. 2011 Jan 5;11:1. doi: 10.1186/1471-2261-11-1.
There is conflicting and only scant evidence on the effect of gender on long-term survival after a myocardial infarction (MI). Our aim was to analyse sex-specific survival of patients for up to 23 years after a first MI in northern Sweden and to describe time trends.
The Northern Sweden MONICA Myocardial Infarction Registry was linked to The Swedish National Cause of Death Registry for a total of 8630 patients, 25 to 64 years of age, 6762 men and 1868 women, with a first MI during 1985-2006. Also deaths before admission to hospital were included. Follow-up ended on August 30, 2008.
Median follow-up was 7.1 years, maximum 23 years and the study included 70 072 patient-years. During the follow-up 45.3% of the men and 43.7% of the women had died. Median survival for men was 187 months (95% confidence interval (CI) 179-194) and for women 200 months (95% CI 186-214). The hazard ratio (HR) for all cause mortality after adjustment for age group was 1.092 (1.010-1.18, P = 0.025) for females compared to males, i.e. 9 percent higher survival in women. After excluding subjects who died before reaching hospital HR declined to 1.017 (95%CI 0.93-1.11, P = 0.7). For any duration of follow-up a higher proportion of women were alive, irrespective of age group. The 5-year survivals were 75.3% and 77.5%, in younger (<57 years) men and women and were 65.5% and 66.3% in older (57-64 years) men and women, respectively. For each of four successive cohorts survival improved. Survival time was longer for women than for men in all age groups.
Age-adjusted survival was higher among women than men after a first MI and has improved markedly and equally in both men and women over a 23-year period. This difference was due to lower risk for women to die before reaching hospital.
关于性别对心肌梗死后长期生存的影响，目前的证据相互矛盾且十分有限。本研究旨在分析在瑞典北部，25 岁至 64 岁首次发生心肌梗死后患者的性别特异性生存率，并描述时间趋势。
将北方瑞典 MONICA 心肌梗死登记处与瑞典国家死因登记处相联系，共纳入 8630 名年龄在 25 岁至 64 岁之间、2006 年期间首次发生心肌梗死的患者，其中男性 6762 名，女性 1868 名。同时还包括在入院前死亡的患者。随访于 2008 年 8 月 30 日结束。
中位随访时间为 7.1 年，最长随访时间为 23 年，研究共包括 70072 人年。随访期间，男性中有 45.3%的患者和女性中有 43.7%的患者死亡。男性的中位生存时间为 187 个月（95%置信区间[CI]为 179-194），女性为 200 个月（95%CI 为 186-214）。调整年龄组后，全因死亡率的危险比（HR）为 1.092（1.010-1.18，P=0.025），女性的生存率比男性高 9%。排除在到达医院前死亡的患者后，HR 降至 1.017（95%CI 为 0.93-1.11，P=0.7）。无论随访时间长短，女性的生存率均高于男性，且不受年龄组的影响。年龄小于 57 岁的男性和女性的 5 年生存率分别为 75.3%和 77.5%，年龄为 57-64 岁的男性和女性的 5 年生存率分别为 65.5%和 66.3%。在四个连续队列中，生存率均有所提高。在所有年龄组中，女性的生存时间均长于男性。
与男性相比，女性在首次发生心肌梗死后的年龄调整生存率更高，且在 23 年期间，男女的生存率均显著且均衡地提高。这种差异是由于女性在到达医院前死亡的风险较低所致。
