Sex differences in management and outcome after acute myocardial infarction in the 1990s - A prospective observational community-based study

Background-previous studies have suggested that women with acute myocardial infarction (AMI) are less aggressively managed than are men. The aim of th is study was to assess sex differences in medical and invasive coronary pro cedures (angiography, PTCA, and CABG) in AMI patients admitted to cardiac c are units (CCUs) in Israel in the mid 1990s and their association with earl y and 1-year prognosis. Methods and Results-We studied 2867 consecutive AMI patients (2125 men, 74% ) hospitalized in all 25 CCUs in Israel from 3 prospective nationwide Surve ys conducted in 1992, 1994, and 1996. Women were, on average, older than me n (69 versus 61 years, P<0.0001) and had a higher prevalence of hypertensio n, diabetes, Killip class <greater than or equal to>II on admission, and in -hospital complications. Women received aspirin and beta -blockers less oft en than did men, but these differences were not significant after age adjus tment. The unadjusted rates of thrombolysis, angiography, and PTCA/CABG use were lower in women than in men but not after covariate adjustment: 42% ve rsus 48% (adjusted odds ratio [OR] 0.92, 95% CI 0.77 to 1.11), 23% versus 3 1% (OR 0.88, 95% CI 0.70 to 1.09), and 15% versus 19% (OR 0.93, 95% CI 0.72 to 1.19), respectively. The 30-day mortality was higher in women than in m en (17.6% versus 9.6%, respectively; OR 1.39, 95% CI 1.06 to 1.82), but the 30-day to 1-year mortality rate was not (9.1% versus 5.6%, respectively; h azard ratio 1.18, 95% CI 0.84 to 1.66). Conclusions-This prospective nationwide observational community-based study of consecutive AMI patients hospitalized in the CCUs in the mid 1990s indi cates that women fare significantly worse than do men at 30 days but not th ereafter at 1-year. The difference in 30-day outcome was not influenced by the use of different therapeutic modalities, including thrombolysis and inv asive coronary procedures, but was rather due to the elder age and greater comorbidity of women: these findings seem also to explain the less frequent use of invasive procedures in women.