COMPARISON OF PRESENTATION, TREATMENT, AND OUTCOME OF ACUTE MYOCARDIAL-INFARCTION IN MEN VERSUS WOMEN - THE MYOCARDIAL-INFARCTION TRIAGE AND INTERVENTION REGISTRY

This study compared the presentation (symptoms and signs), treatment, and outcome of 1,097 consecutive patients (851 men and 246 women) from the Myocardial Infarction Triage and intervention (MITI) Project Regi stry with confirmed acute myocardial infarction (AMI), all of whom wer e initially evaluated in the prehospital setting, met clinical criteri a for possible thrombolysis, and were followed throughout their hospit al course. Women were older than men and had a higher prevalence of kn own cardiovascular risk factors, including systemic hypertension and c ongestive heart failure, The presentation of AMI with respect to sympt oms, delay, and hemodynamic and electrocardiographic findings was for the most part indistinguishable between men and women. Women appeared ''undertreated'' early in the course of AMI and were half as likely as men to undergo acute catheterization, angioplasty, thrombolysis, or c oronary bypass surgery (odds ratio 0.5 [0.3 to 0.7]). The risk for hos pital mortality in women was almost twice that for men (odds ratio 1.9 5 [1.01 to 3.8]). Hospital mortality after AMI was also independently predicted by older age, early evidence of hemodynamic instability, and an intraventricular conduction abnormality on the initial electrocard iogram, Although similar in its presentation, AMI in women is not as a ggressively treated, and results in a less favorable outcome than in m en. Gender as well as nongender-specific risk factors are important in assessing risk and the likelihood of early intervention after AMI.