INFLUENCE OF GENDER IN THE THERAPEUTIC MANAGEMENT OF PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION IN ISRAEL

A national study was performed in early 1992 in the 25 operating coron ary care units in Israel, which enabled the assessment of whether the therapeutic management of patients with acute myocardial infarction wa s affected by patient gender. During a 2-month period, 1,014 consecuti ve patients with acute myocardial infarction were hospitalized. Thromb olytic therapy was given to 47% of men (362 of 769), and 43% of women (106 of 245) (p = NS). After adjustment for age, no gender differences in the administration of thrombolytic therapy were noted (odds ratio 0.95; 95% confidence interval 0.73-1.23). Coronary angiography was mor e frequently performed in men (22%) than in women (16%) (p <0.05). How ever, no gender differences in the use of angioplasty or coronary bypa ss surgery performed during the index hospitalization were found (10% in men, and 8% in women). The main reasons for ineligibility for throm bolytic therapy were: late hospital arrival, absence of qualifying ST- T changes on admission electrocardiogram, and contraindications to thr ombolytic therapy. Hospital death was significantly lower in patients receiving thrombolytic therapy (37 of 456; 8%) than in those excluded from thrombolysis (70 of 540; 13%) (p <0.01). This difference was sign ificant for men, but not for women. The 1-year postdischarge mortality was 4% in patients treated compared with 12% in those ineligible for thrombolysis (p <0.01). This significant difference persisted among me n and women.