Sex differences in medical care and early death after acute myocardial infarction.
BACKGROUND
Women receive less evidence-based medical care than men and have higher rates of death after acute myocardial infarction (AMI). It is unclear whether efforts undertaken to improve AMI care have mitigated these sex disparities in the current era.


RESULTS
Using the Get With the Guidelines-Coronary Artery Disease database, we examined sex differences in care processes and in-hospital death among 78 254 patients with AMI in 420 US hospitals from 2001 to 2006. Women were older, had more comorbidities, less often presented with ST-elevation myocardial infarction (STEMI), and had higher unadjusted in-hospital death (8.2% versus 5.7%; P<0.0001) than men. After multivariable adjustment, sex differences in in-hospital mortality rates were no longer observed in the overall AMI cohort (adjusted odds ratio [OR]=1.04; 95% CI, 0.99 to 1.10) but persisted among STEMI patients (10.2% versus 5.5%; P<0.0001; adjusted OR=1.12; 95% CI, 1.02 to 1.23). Compared with men, women were less likely to receive early aspirin treatment (adjusted OR=0.86; 95% CI, 0.81 to 0.90), early beta-blocker treatment (adjusted OR=0.90; 95% CI, 0.86 to 0.93), reperfusion therapy (adjusted OR=0.75; 95% CI, 0.70 to 0.80), or timely reperfusion (door-to-needle time </=30 minutes: adjusted OR=0.78; 95% CI, 0.65 to 0.92; door-to-balloon time </=90 minutes: adjusted OR=0.87; 95% CI, 0.79 to 0.95). Women also experienced lower use of cardiac catheterization and revascularization procedures after AMI.


CONCLUSIONS
Overall, no sex differences in in-hospital mortality rates after AMI were observed after multivariable adjustment. However, women with STEMI had higher adjusted mortality rates than men. The underuse of evidence-based treatments and delayed reperfusion among women represent potential opportunities for reducing sex disparities in care and outcome after AMI.
Jneid
Hani
H
Division of Cardiology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX 77030, USA. jneid@bcm.tmc.edu
Fonarow
Gregg C
GC
Cannon
Christopher P
CP
Hernandez
Adrian F
AF
Palacios
Igor F
IF
Maree
Andrew O
AO
Wells
Quinn
Q
Bozkurt
Biykem
B
Labresh
Kenneth A
KA
Liang
Li
L
Hong
Yuling
Y
Newby
L Kristin
LK
Fletcher
Gerald
G
Peterson
Eric
E
Wexler
Laura
L
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D012042:Registries; D012727:Sex Characteristics; D016896:Treatment Outcome