Objective-To determine whether women with myocardial infarction are tr
eated differently from men of the same age and to assess the effect of
changes in the coronary care unit admission policy. Design-Clinical a
udit. Setting-The coronary care unit and general medical wards of a te
aching hospital. In 1990 the age limit for admission to coronary care
was 65 years. This age Limit was removed in 1991. Patients-539 female
and 977 male patients admitted with myocardial infarction between 1990
and 1992. Main outcomes-Admission to the coronary care unit, administ
ration of thrombolysis, and in-hospital mortality. Results-409 men and
254 women-were admitted with myocardial infarction in 1990 and 568 me
n and 285 women in 1992. Removal of the age limit for admission to the
coronary care unit resulted in an increase in the numbers of both sex
es admitted with myocardial infarction. In both years, however, propor
tionately more men with infarction were admitted to coronary care: 226
men (55%) and 96 women (38%) (P < 0.01) (95% CI 7 to 28) in 1990 and
459 men (81%) and 200 women (70%) (P < 0.01) (%CI 2 to 19) in 1992. So
me 246 men (60%) and 133 women (52%) with infarction (P < 0.01) receiv
ed thrombolytic treatment in 1990 compared with 319 men (56%) and 130
women (46%) (P < 0.01) in 1992. The mean age of women sustaining a myo
cardial infarction was significantly greater in both years studied. In
1992 a total of 78 men (7%) and 34 women (4%) (P < 0.05) admitted wit
h chest pain underwent cardiac catheterisation before discharge from h
ospital. Conclusions-Differences in admission rates to the coronary ca
re unit and the rate of thrombolysis between the sexes can be explaine
d by the older age of women sustaining infarction. The application of
age limits for admission to coronary care or administration of thrombo
lysis places elderly patients at a disadvantage. As women sustain myoc
ardial infarctions at an older age they are placed at a greater disadv
antage.