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Sex differences in hospital mortality following acute myocardial infarction in China: findings from a study of 45 852 patients in the COMMIT/CCS-2 study
  1. Yiping Chen1,2,
  2. Lixin Jiang2,
  3. Margaret Smith1,
  4. Hongchao Pan1,
  5. Rory Collins1,
  6. Richard Peto1,
  7. Zhengming Chen1,2,
  8. for the COMMIT/CCS-2 collaborative group
  1. 1Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
  2. 2China Oxford Centre for International Health Research, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, PR China
  1. Correspondence to Dr Yiping Chen, CTSU, Richard Doll Building, Old Road Campus, University of Oxford, Oxford OX3 7LF, UK; yiping.chen{at}


Objective To assess the sex difference in hospital mortality following ST elevation myocardial infarction (STEMI) in China.

Design Observational study of patients enrolled into a large trial, adjusting for age, presenting characteristics and hospital treatments using logistic regression.

Settings 1250 hospitals in China during 1999–2005.

Patients 42 683 STEMI patients, including 31 309 men and 11 374 women.

Intervention In the original trial, all patients received 162 mg of aspirin plus 75 mg of clopidogrel daily or matching placebo and metoprolol (15 mg intravenous then 200 mg oral daily) or matching placebo. All other aspects of patients' treatments were at the discretion of responsible doctors.

Major outcomes Hospital mortality from any cause during the scheduled trial treatment period (ie, up to 4 weeks in hospital).

Results Overall, 8% of the patients died in hospital, with the crude hospital mortality being twice as high in women as in men (12.6% vs 6.3%). After adjusting for age, the sex difference in hospital mortality attenuated but remained highly significant (OR 1.54; 95% CI 1.43 to 1.66). Further adjustment for other baseline characteristics and for the treatments given in hospital had little effect on the sex difference in hospital mortality (OR 1.50, 95% CI 1.38 to 1.62). The difference in hospital mortality was greater at a younger age, with the adjusted ORs being 2.14, 1.70, 1.48 and 1.18, respectively, for ages <55, 55–64, 65–74 and ≥75 years (p=0.0001 for trend).

Conclusion Compared with men of the same age, women had approximately a 50% higher mortality following hospital admission for STEMI, with a particularly higher excess risk at age <55 years.

  • Coronary artery disease
  • gender

Statistics from


  • Funding The original trial was funded by Sanifo-Aventis and AstraZeneca. It was, however, designed, conducted, analysed and interpreted independently of the companies, in collaboration between the Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU) and Fuwai Hospital. The present report is supported only by the core funding to the CTSU from the UK Medical Research Council and British Heart Foundation. CTSU has a staff policy of not accepting honoraria or other payments from pharmaceutical industry, except for the reimbursement of costs to participate in scientific meetings.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by Chinese Academy of Medical Sciences, Fuwai Hospital.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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