Are women with acute myocardial infarction managed as well as men? Does ithave consequences on in-hospital mortality? Analysis of an unselected cohort of 801 women and 1,718 men.

Objective-This study sought to compare characteristics and management of my ocardial infarction in men and women, and whether a difference in managemen t would translate into a difference in in-hospital mortality. Methods and results-Data were prospectively collected in 2,519 patients (80 1 women) admitted in all hospitals in three departments in the Rhone-Alpes region in France between September 1, 1993 and January 31, 1995. Women were older than men (76 vs. 64 years). The interval between symptom onset and i nitial medical intervention was longer in women than in men (median: 180 vs . 135 minutes), as was the interval between symptom onset and hospital admi ssion (median: 315 vs. 255 minutes). After age-adjustment, women were less often smokers, and more often hypertensive or diabetic than men, location o f infarction was more often anterior in women, as congestive heart failure at admission. In multivariate analysis, thrombolysis rate was not significa ntly different in both sexes, whereas noninvasive tests, coronary arteriogr aphy, percutaneous transluminal coronary angioplasty, and coronary artery b ypass grafting were significantly less often performed in women than in men . Although in-hospital mortality was higher in women than in men (21% vs. 1 1%), this difference disappeared after age-adjustment (relative risk = 0.99 ). In multivariate analysis, gender was not an independent predictor of sur vival. Conclusions-Although in-hospital mortality after myocardial infarction was similar in both sexes, rates of diagnostic and therapeutic procedures were lower in women than in men. This raises the question of whether mortality w ould decrease in women if management were similar in both sexes.