INFLUENCE OF GENDER ON CARDIOVASCULAR MORTALITY IN ACUTE MYOCARDIAL-INFARCTION PATIENTS WITH HIGH INDICATION FOR CORONARY ANGIOGRAPHY

Background This study was undertaken to study gender differences in th e use of coronary angiography (CA), revascularization (RV), and cardio vascular disease (CVD) mortality in patient with acute myocardial infa rction (AMI) who were assigned to ''High Indication for CA'' per the A merican College of Cardiology/American Heart Association (ACC/ ANA) pr actice guidelines. Methods and Results This is a historical prospectiv e study based on a stratified random sample of 1165 AMI patients from January 1990 to December 1992 at seven health maintenance organization hospitals. CA was highly indicated in 286 women and 564 men. In a Cox hazard ratio (HR), women received significantly (P<.O5) fewer CAs (H R,.78) and RVs (HR, .62*) than men after adjusting for age, Charlson index, and congestive heart failure. Crude CVD mortality for women was higher than men (HR, 1.7). After adjustments for age, Charlson index , and congestive heart failure, the HR was reduced to 1.19 for women. Further adjustment for CA and RV lowered CVD mortality in women slight ly (HR, 1.14). RV is associated with lowered CVD (HR,.41). Conclusion s In patients with high indication for CA, use of CA and RV was signif icantly lower in women. After adjustments were made for risk profile a nd treatment modalities, women did not have a significantly increased risk for CVD compared with men. However, the apparent protective effec t of RV in patients with a high indication for CA suggests that practi ces in line with ACC/AHA guidelines may reduce CVD in both women and m en.