Do race and gender influence the use of invasive procedures?

OBJECTIVE: To assess the influence of race and gender on the use of invasiv e procedures in patients with acute myocardial infarction (AMI) in communit y hospitals. DESIGN: Prospective, observational. SETTING: Five mid-Michigan community hospitals. PATIENTS: All patients (838) identified with AMI between January 1994 and A pril 1995 in 1 of these hospitals. MEASUREMENTS AND MAIN RESULTS: After adjusting for age, hospital of admissi on, insurance type, severity of AMI, and comorbidity, using white men as th e reference group, the rate of being offered cardiac catheterization (CC) w as 0.88 (95% confidence interval [CI], 0.60 to 1.29) for white women; 0.79 (95% CI, 0.41 to 1.50) for black men; and 1.14 (95% CI, 0.53 to 2.45) for b lack women. Among patients who underwent CC, after also adjusting for coron ary artery anatomy, the rate of being offered angioplasty, using white men as the reference group, was 1.22 (95% CI, 0.75 to 1.98) for white women: 0. 61 (95% CI, 0.29 to 1.28; P = .192) for black men; and 0.40 (95% CI, 0.14 t o 1.13) for black women. The adjusted rate of being offered bypass surgery was 0.47 (95% CI, 0.24 to 0.89) for white women; 0.36 (95% CI, 0.12 to 1.06 ) for black men; and 0.37 (95% CI, 0.11 to 1.28) for black women. CONCLUSIONS: Our study shows that white women are less Likely than white me n to be offered bypass surgery after AMI. Although black men and women with AMI are less likely than white men to be offered percutaneous transluminal coronary angioplasty or coronary artery bypass grafting in bath unadjusted and adjusted analyses, these findings did not reach statistical significan ce. Our study is limited in power due to the small number of blacks in the sample.