DIFFERENCES IN TREATMENT OF ACUTE MYOCARDIAL-INFARCTION BY SEX, AGE, AND OTHER FACTORS (THE STANFORD 5-CITY PROJECT)

This study examines the temporal trends in the use of angiography foll owed by revascularization procedures for acute myocardial infarction ( AMI) in 2,021 hospitalized men and 995 women aged 30 to 74 years who p articipated in the Stanford Five-City Project during the years 1986 to 1992. Our sample included hospitalized patients who received a discha rge diagnosis code of 410 through 414 and met study criteria for eithe r a definite or possible AMI. Incident and recurrent infarctions occur ring in the years 1986 through 1992 were included, but only the first event in this period for each patient. We performed stepwise multiple logistic regression analysis to determine the probability of: (1) rece iving coronary angiography, (2) revascularization by either coronary b ypass surgery or angioplasty among those with angiogram, and (3) throm bolytic therapy, Age, year of procedure, disease severity, and time be tween symptom onset and medical treatment were included as covariates. After adjustment of these factors, women were less likely than men to undergo angiography but were equally likely to undergo revascularizat ion and thrombolysis. Hispanics and whites were equally likely to rece ive angiography and thrombolysis, but Hispanics were less likely than whites to undergo revascularization. Age and disease severity were inv erse predictors of coronary angiography but not of revascularization. Age, severity, and delay time between onset of symptoms and medical th erapy were inverse predictors of thrombolysis; delay rime was signific antly greater in women than in men and averaged >6 hours in both sexes . The likelihood of receiving angiography, revascularization, and thro mbolysis increased sharply over the study period.