Background

We aimed to assess sex difference in developing major adverse cardiovascular events (MACEs) after discharge and factors associated with the gender disparity among AMI survivors.

Methods

We selected the patients hospitalized with either NSTEMI or STEMI from 101 Chinese centers in the CPACS 3 study. We compared sex differences in MACEs and mortality in 6 months after discharge using a Cox proportional hazards model, following sequential adjustment for covariates.

Results

8958 patients with AMI were included and 30.3% were women. Overall, the crude rate of MACEs at 6 month for women were significantly higher than men (6.5% vs 4.5%; hazard ratio (HR) =1.47; 95% CI, 1.21–1.77). Women also had significantly higher total mortality compared to men (4.4% vs 2.7%; HR = 1.65; 95% CI, 1.30–2.09). Among possible explanatory factors, patients' cardiovascular risk profile might explain 53%, age 38%, low level of education and socioeconomic status 32%. Interestingly, medications at discharge did not contribute to the sex disparity in 6-month risk of MACEs. These factors could explain a similar proportion of the gender disparity in total death. All together, these factors could explain all the disparity in the risk of both MACEs (HR = 1.05,95% CI, 0.85–1.31) and total death (HR = 1.00,95% CI,0.76–1.30).

Conclusions

The gender disparity in MACEs and total death among AMI patients continues at 6 months after discharged surviving. Multiple factors could explain the higher risk for women, including poorer cardiovascular risk factor profile, older age and lower socioeconomic status.

Trial Registration

CPACS-3 was registered on www.clinicaltrails.gov, and the registration number is NCT01398228.