Sex differences in health outcomes at one year following acute myocardial infarction: A report from the China Patient-Centered Evaluative Assessment of Cardiac Events prospective acute myocardial infarction study

Background: We examined sex differences in long-term health outcomes following acute myocardial infarction in China, including mortality, major adverse cardiac events and health status (symptoms, functioning, quality of life). Methods: A total of 3415 acute myocardial infarction patients (23.2% women) aged > 18 years were enrolled across 10 geographic regions in China (2012-2014) in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) study. Clinical data was abstracted from medical records. Generic (Euro-Quality of Life Scale) and disease-specific (Seattle Angina Questionnaire) health status was obtained through interviews at baseline and one year. Results: At one year, women with acute myocardial infarction had a higher risk of death from all causes (p<0.001), but had similar rates of major adverse cardiac events (p=0.2). Women had lower mean generic (Euro-Quality of Life Scale utility index score: 0.90 +/- 0.13 vs 0.94 +/- 0.11) and disease specific health scores indicating poorer functioning (Seattle Angina Questionnaire summary score: 75.3 +/- 11.4 vs 78.4 +/- 9.7) and higher rates of daily/weekly angina (Seattle Angina Questionnaire angina frequency score <= 60 vs >60: 9.1% vs 4.7%; all p<0.001). In multivariable analysis, there was a significant association between female sex and mortality (beta=0.45, standard error=0.21, p=0.03) but not for major adverse cardiac events (beta=-0.02, standard error=0.14, p=0.89). The association between female sex and worse generic health status persisted (beta=-0.02, standard error=0.01, p=0.003), but was no longer significant between sexes for disease-specific health status (beta=-0.82, standard error=0.58, p=0.154) or daily/weekly angina (odds ratio=1.39; 95% confidence interval 0.88-2.21). Conclusion: Women in China have higher crude rates of all-cause/cardiovascular death versus men, as well as worse generic/disease specific health status at one-year post-acute myocardial infarction. The association between female sex and worse generic health status persisted following adjustment.