{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T22:58:51Z","timestamp":1766530731817,"version":"3.48.0"},"reference-count":20,"publisher":"BMJ","issue":"6954","license":[{"start":{"date-parts":[[1994,9,3]],"date-time":"1994-09-03T00:00:00Z","timestamp":778550400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"accepted":{"date-parts":[[1994,7,29]]},"published-print":{"date-parts":[[1994,9,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Objective<\/jats:bold>\n                    : To examine the influence that being female has on the outcome of acute myocardial infarction.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Design<\/jats:bold>\n                    : Observational follow up study.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Setting<\/jats:bold>\n                    : London district general hospital.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Patients<\/jats:bold>\n                    : 216 women and 607 men with acute myocardial infarction admitted to a coronary care unit from 1 January 1988 to 31 December 1992.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Main outcome measures<\/jats:bold>\n                    : All cause mortality and recurrent ischaemic events in the first six months.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results<\/jats:bold>\n                    : Event free survival (95% confidence interval) at six months was 63.3% (56.3% to 69.4%) in women and 76.1% (72.4% to 79.4%) in men, P&lt;0.001. The difference was confined to the first 30 days but thereafter the hazard plots for women and men converged, with reduction of the hazard ratio from 2.36 (1.70 to 3.27) to 0.81 (0.44 to 1.48). Women were older, but their excess risk persisted after adjustment for age, other baseline variables, and indices of severity of infarction (hazard ratio 1.53 (1.09 to 2.15), P=0.015). Women tended to be treated with thrombolysis less commonly than men but the difference was small. Substantially fewer women than men, however, were discharged taking \u00df blockers (23.3% v 41.4%, P &lt;0.001), and although additional adjustment for discharge treatment did not further reduce the point estimate of the hazard ratio (1.84 (0.89-3.83)), the 95% confidence interval was wide and statistical significance was lost.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions<\/jats:bold>\n                    : Women with acute myocardial infarction have a worse prognosis than men but the excess risk is confined to the first 30 days and is only party explained by age and other baseline variables. The tendency for women to receive less vigorous treatment than men must be remedied before gender can be considered to be an independent determinant of risk.\n                  <\/jats:p>","DOI":"10.1136\/bmj.309.6954.566","type":"journal-article","created":{"date-parts":[[2011,10,27]],"date-time":"2011-10-27T19:30:16Z","timestamp":1319743816000},"page":"566-569","source":"Crossref","is-referenced-by-count":58,"title":["Acute myocardial infarction in women: survival analysis in first six months"],"prefix":"10.1136","volume":"309","author":[{"given":"P","family":"Wilkinson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Laji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Ranjadayalan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Parsons","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A D","family":"Timmis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1994,9,3]]},"reference":[{"key":"2025122311295667000_309.6954.566.1","doi-asserted-by":"crossref","unstructured":"Tofler GH Stone PH Muller JE Willich SN Davis VG Poole K et al. Effects of gender and race on prognosis after myocardial infarction: adverse prognosis for women, particularly black women. J Am Coll Cardiol 1987:473-82.","DOI":"10.1016\/S0735-1097(87)80038-4"},{"key":"2025122311295667000_309.6954.566.2","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1161\/01.CIR.83.2.484","article-title":"In-hospital and 1-year mortality in 1524 women after myocardial infarction: comparison with 4315 men.","volume":"83","author":"Greenland","year":"1991","journal-title":"Circulation"},{"key":"2025122311295667000_309.6954.566.3","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.88.6.2548"},{"key":"2025122311295667000_309.6954.566.4","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/S0735-1097(98)90048-1","article-title":"Risk factors and in- hopital course of first episode of myocardial infarction or acute coronary insufficiency in women.","volume":"11","author":"Robinson","year":"1988","journal-title":"J Am Coll Cardiol"},{"key":"2025122311295667000_309.6954.566.5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0002-9149(88)91356-2","article-title":"Acute myocardial infarction in women: influence of gender on mortality and prognostic variables.","volume":"62","author":"Dittrich","year":"1988","journal-title":"Am J Cardiol"},{"key":"2025122311295667000_309.6954.566.6","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1161\/01.CIR.85.1.172","article-title":"Trends in survival of hospitalized myocardial infarction patients between 1970 and 1985: the Minnesota heart survey.","volume":"85","author":"McGovern","year":"1992","journal-title":"Circulation"},{"key":"2025122311295667000_309.6954.566.7","doi-asserted-by":"crossref","first-page":"1780","DOI":"10.1016\/0735-1097(93)90757-R","article-title":"Thrombolytic therapy for women with myocardial infarction: is there a gender gap?","volume":"22","author":"Lincoff","year":"1993","journal-title":"J Am Coll Cardiol"},{"key":"2025122311295667000_309.6954.566.8","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1056\/NEJM199107253250401","article-title":"Differences in the use of procedures between women and men hospitalized for coronary heart disease.","volume":"325","author":"Ayanian","year":"1991","journal-title":"N Engl J Med"},{"key":"2025122311295667000_309.6954.566.9","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1056\/NEJM199107253250402","article-title":"Sex differences in the management of coronary artery disease.","volume":"325","author":"Steingart","year":"1991","journal-title":"N Engl J Med"},{"key":"2025122311295667000_309.6954.566.10","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1136\/bmj.306.6886.1164","article-title":"Coronary artery surgery: are women discriminated against?","volume":"306","author":"Pettigrew","year":"1993","journal-title":"BMJ"},{"key":"2025122311295667000_309.6954.566.11","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1136\/bmj.307.6915.1305","article-title":"Access to coronary catheterisation: fair shares for all?","volume":"307","author":"Kee","year":"1993","journal-title":"BMJ"},{"key":"2025122311295667000_309.6954.566.12","doi-asserted-by":"crossref","first-page":"561","DOI":"10.7326\/0003-4819-112-8-561","article-title":"Increased mortality of women in coronary artery bypass surgery: evidence for referral bias.","volume":"112","author":"Kahn","year":"1990","journal-title":"Ann Intern Med"},{"key":"2025122311295667000_309.6954.566.13","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1136\/bmj.307.6900.349","article-title":"Short and long term prognosis of acute myocardial infarction since introduction of thrombolysis.","volume":"307","author":"Stevenson","year":"1993","journal-title":"BMJ"},{"key":"2025122311295667000_309.6954.566.14","unstructured":"Kalbfleisch JD Prentice RL . The statistical analysis of failure time data. London: John Wiley, 1980:10-9."},{"key":"2025122311295667000_309.6954.566.15","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.2517-6161.1972.tb00899.x","article-title":"Regression models and life tables (with discussion).","volume":"34","author":"Cox","year":"1972","journal-title":"Journal of the Royal Statistical Society (series B)"},{"key":"2025122311295667000_309.6954.566.16","first-page":"00","volume":"1","year":"1993","journal-title":"Stata reference manual, release 3.1, vol 2. 6th ed."},{"key":"2025122311295667000_309.6954.566.17","doi-asserted-by":"crossref","unstructured":"Tunstall-Pedoe H Clayton D Morris JN Brigden W McDonald L. Coronary heart-attacks in east London. 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