Previous studies have suggested that women may be at higher risk of death after ST-segment elevation myocardial infarction (STEMI). We studied potential associations of gender and age with in-hospital mortality using a registry of 31,689 consecutive patients with STEMI aged ≥30 years (66.3% men, mean age 67.8 years) treated in 22 hospitals. Total in-hospital mortality rate of STEMI was 11.2%. Women had higher unadjusted mortality rate compared with men (17.5% vs 8.0%; hazard ratio 1.65; 95% confidence interval [CI] 1.54 to 1.76, p <0.0001). However, when adjusted for age and co-morbidities, there was no difference in mortality between genders overall (hazard ratio 1.04; 95% CI 0.97 to 1.12, p = 0.2303) or at any age group. Mortality rate was highly dependent of age with an estimated increase of 86% (95% CI 80% to 92%) per 10-year increase in age (p <0.0001). Chronic coronary, peripheral, or cerebral artery disease, diabetes, renal insufficiency, malignancy, and severe infection were independent predictors of mortality in multivariate analysis. Atrial fibrillation was associated with survival in multivariate model. Anterior location of STEMI was not independently associated with in-hospital mortality. In conclusion, although women have higher total in-hospital mortality rate than men after STEMI, this difference does not appear to be caused by gender itself but to be due to of differences in age and co-morbidities.

Despite evolving treatments and shortening delays of reperfusion therapy, ST-segment elevation myocardial infarction (STEMI) still causes significant mortality.¹ Presentation and complications of STEMI differ between genders² because of yet unclear mechanisms. Previous studies have resulted in conflicting results on potential gender difference in mortality after STEMI. A number of studies have suggested women to be at higher risk of death after STEMI,^{1, 3, 4, 5, 6, 7, 8 and 9} whereas others have found no mortality difference between genders.^{10 and 11} Potential gender effect may be age dependent as women in the youngest age groups have been reported to have highest mortality excess compared with men.³ To further clarify the possible gender bias in STEMI mortality, we studied associations of gender and age with in-hospital mortality using a large-scale multihospital registry data.