Treatment of acute myocardial infarction and 30-day mortality among women and men.

Background: Previous studies have suggested that women with acute myocardia l infarction receive less aggressive therapy than men. We used data from th e Cooperative Cardiovascular Project to determine whether women and men who were ideal candidates for therapy after acute myocardial infarction were t reated differently. Methods: Information was abstracted from the charts of 138,956 Medicare ben eficiaries (49 percent of them women) who had an acute myocardial infarctio n in 1994 or 1995. Multivariate analysis was used to assess differences bet ween women and men in the medications administered, the procedures used, th e assignment of do-not-resuscitate status, and 30-day mortality. Results: Among ideal candidates for therapy, women in all age groups were l ess likely to undergo diagnostic catheterization than men. The difference w as especially pronounced among older women; for a woman 85 years of age or older, the adjusted relative risk was 0.75 (95 percent confidence interval, 0.68 to 0.83). Women were somewhat less likely than men to receive thrombo lytic therapy within 60 minutes (adjusted relative risk, 0.93; 95 percent c onfidence interval, 0.90 to 0.96) or to receive aspirin within 24 hours aft er arrival at the hospital (adjusted relative risk, 0.96; 95 percent confid ence interval, 0.95 to 0.97), but they were equally likely to receive beta- blockers (adjusted relative risk, 0.99; 95 percent confidence interval, 0.9 5 to 1.03) and somewhat more likely to receive angiotensin-converting-enzym e inhibitors (adjusted relative risk, 1.05; 95 percent confidence interval, 1.02 to 1.08). Women were more likely than men to have a do-not-resuscitat e order in their records (adjusted relative risk, 1.26; 95 percent confiden ce interval, 1.22 to 1.29). After adjustment, women and men had similar 30- day mortality rates (hazard ratio, 1.02; 95 percent confidence interval, 0. 99 to 1.04). Conclusions: As compared with men, women receive somewhat less aggressive t reatment during the early management of acute myocardial infarction. Howeve r, many of these differences are small, and there is no apparent effect on early mortality. (N Engl J Med 2000;343:8-15.) (C) 2000, Massachusetts Medi cal Society.