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To the Editor: I read with interest the article by Marrugat et al¹ concerning the mortality differences between men and women following first myocardial infarction (MI). The authors found that women's more than 70% greater risk of death than men after a first MI may be attributable to the more severe nature and complications associated with MIs among women. But no mention was made of cardiac rupture, which is the most serious complication of an acute MI.

Almost 4% of all patients admitted for acute MI die of free wall rupture; this rate had not changed during the past 16 years while overall mortality of acute MI decreased dramatically.² In fact, according to Braunwald,³ free wall rupture is responsible for 15% of all deaths from acute MI.

Myocardial rupture is 3 times greater in frequency in patients during their first acute MI than in those with a prior infarct that . . . [Full Text of this Article]

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Mortality Differences Between Men and Women Following First Myocardial Infarction
Jaume Marrugat, Joan Sala, Rafel Masiá, Marco Pavesi, Ginés Sanz, Vicente Valle, Lluis Molina, Lluis Serés, Roberto Elosua, and for the RESCATE Investigators
JAMA. 1998;280(16):1405-1409.
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