In general, women present to hospital with symptoms and signs of coronary artery disease at a later age than males; furthermore, they often present with atypical symptoms.  While a large amount of work has been directed towards examining sex differences in mortality, few studies have taken into account age difference when doing so.

In this observational study from the US National Registry of Myocardial Infarction between 1994 and 2006, Canto et al. examined predictors of myocardial infarction (MI) presentation without chest pain, and the relationship between age, gender, and hospital mortality.  The authors found that far more women than men presented with an MI without any chest pain (42.0% [95% CI, 41.8%-42.1%] vs 30.7% [95% CI, 30.6%-30.8%]; P < .001). They also noted a  significant interaction between age and sex with chest pain at presentation, with a larger sex difference seen in younger patients, which became attenuated with advancing age.  Younger women presenting without chest pain had greater hospital mortality than younger men without chest pain, and these sex differences decreased or even reversed with advancing age.  The 3-way interaction between sex, age, and chest pain on mortality was significant (P < .001).

Conclusion:

This study found that women were more likely than men to present with an MI without chest pain, and that a higher mortality was seen compared to men within the same age group.  However, it also found that these changes were attenuated with increasing age.

• Canto JG, Rogers WJ, Goldberg RJ, et al.  Association of Age and Sex With Myocardial Infarction Symptom Presentation and In-Hospital Mortality.  JAMA 2012; 307(8):813-822.