Little is known about sex difference of middle-term mortality rates in patients surviving an ACS and about comparison with mortality rates in the corresponding healthy population. Our aims were: 1/to review the sex difference mortality at short-term (28 day) in ACS patients, 2/to describe short-term mortality in relation with middle-term mortality (4 years), 3/to compare sex difference of middle-term mortality in patients surviving an ACS with the corresponding population. 6022 patients hospitalized for a first ACS registered in the Strasbourg (BR), Lille and Toulouse (HG) MONICA registries, between 2009 and 2011 were included. ACS were defined as STEMI, NSTEMI, or unstable angina (UA). Mean follow-up was 50.3 months. 3025 patients (50.2%) were STEMI, 1571 (26.1%) NSTEMI and 1426 (23.6%) UA.

Short-term mortality was 6.7% in men vs 9.0% in women for STEMI (p=0.05), 4.7% vs 4.2% for NSTEMI (p=0.67) and 5.2% vs 6.6% for UA (p=0.29). Middle-term mortality was 7.4% in men and 8.5% in women for STEMI (p=0.39), 11.5% vs 11.9% for NSTEMI (p=0.82) and 8.6% vs 10.9% for UA (p=0.20). The small higher short-term and middle-term mortality in women was removed after adjustment for age and center. In men the middle-term risk of death for STEMI compared with the corresponding population was 3.05 [2.32-4.02] in HG, 2.88 [2.25-3.68] in BR and 2.34 [1.83-2.99] in Lille. In women the risk of death was 6.80 [4.03-11.5], 5.04 [3.04-8.37] and 6.40 [4.28-9.58] in HG, BR and Lille respectively. Considering males and females together, middle-term mortality of STEMI for HG was in relation to the regional population 3.26 [2.56-4.15] and to the French population 4.17 [3.27-5.32], for BR 3.53 [2.83-4.41] vs 3.74 [6.00-4.67] and for Lille 4.40 [3.57-5.43] vs 3.42 [2.78-4.22]. Short-term and middle-term mortality were similar in men and women. In patients surviving an ACS, middle-term mortality was, comparatively to the corresponding population, from 2 to 3 times higher in women than in men.