title: Age-related differences in the delivery of cardiac management to women versus men with acute myocardial infarction in Japan: Tokai Acute Myocardial Infarction Study: TAMIS.
abstract: It is of concern that women are more likely to undergo fewer diagnostic tests and receive less treatment for acute myocardial infarction (AMI) than men. However, it is still unclear whether gender differences exist according to age groups. Therefore, we studied the influence of gender on the delivery of cardiac management according to two age groups (< 65, >or= 65) in Japan. Data from the Tokai Acute Myocardial Infarction Study (TAMIS) sample were used. This is a retrospective study of all consecutive patients admitted to the 13 acute care hospitals in the Tokai region of Japan, which includes Aichi and Shizuoka Prefectures, with a diagnosis of AMI from 1995 to 1997. A total of 143 younger women, 822 younger men, 391 older women, and 611 older men were included. Information concerning patient demographics, in-hospital course, comorbid conditions, electrocardiography (ECG), ultrasound-echocardiography (UCG), treadmill test (TMT), coronary angiography (CAG), percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG), intra-aortic balloon pump (IABP), mechanical ventilation, and in-hospital or discharge medication (thrombolytics, vasopressors, aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium antagonists, nitrates) were collected. Among the young, after controlling for these baseline variables, women were significantly less likely to undergo PTCA compared to men (OR, 0.54, 95%CI, 0.35-0.82). After controlling for these baseline variables, only lipid-lowering therapy tended to be more frequent in women than in men among the elderly (OR, 2.79, 95%CI, 1.47-2.58). The findings suggest that younger women with AMI are less likely than younger men to undergo PTCA, and that older women with AMI are more likely to receive lipid-lowering therapy.
authors.affiliation: Department of Geriatrics, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Hirakawa
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Masuda
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Uemura
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kuzuya
authors.forename: Takaya
authors.initials: T
authors.lastname: Kimata
authors.forename: Akihisa
authors.initials: A
authors.lastname: Iguchi
mesh_terms: D017677:Age Distribution; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D017023:Coronary Angiography / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D012189:Retrospective Studies; D017678:Sex Distribution; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data