Significance of the invasive strategy after acute myocardial infarction on prognosis and secondary preventive medication: a nationwide study of 6364 women and 11,915 men.
OBJECTIVE
To describe gender-specific long-term outcome and initiation of secondary preventive medication among patients with acute myocardial infarction (AMI).


METHODS
Observational cohort study.


METHODS
Nationwide registries.


METHODS
We included 18,279 patients: 6364 women (35%) and 11,915 men (65%), admitted with AMI (median age, 67 years; range, 30-90 years) surviving for at least 2 months.


METHODS
According to sex, patients were stratified by invasive treatment strategy: (1) revascularized; (2) examined with coronary angiography (CAG) but not revascularized; and (3) not examined with CAG.


METHODS
All-cause mortality and readmission with AMI. Initiation of secondary preventive medication.


RESULTS
Of 18,279 patients with a first AMI who survived 2 months, 1857 women (29%) and 1756 men (15%) were not examined with CAG (P<.001), 1295 women (20%) and 1563 men (13%) were examined but not revascularized (P<.001), and 3212 women (51%) and 8596 men (72%) were revascularized (P<.001). Not being examined with CAG after AMI was associated with a three-fold increase in risk of death and, importantly, a 50% increase in the risk of a recurrent AMI compared with patients who were revascularized. Among patients who were revascularized, 85-92% initiated recommended secondary preventive medication compared to 46-71% in patients not examined with CAG (P<.001). Initiation of secondary preventive medication was higher in men (81-84%) than in women (73-79%; P<.001), which could be ascribed to the differences in invasive strategy.


CONCLUSIONS
In both sexes, those who were not examined had a highly increased risk of both recurrent AMI and death. Moreover, initiation of secondary preventive medication was closely related to the choice of invasive strategy disfavoring the women.
National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK1399, Copenhagen K, Denmark. hvelplund@dadlnet.dk
Anders
A
Hvelplund
Søren
S
Galatius
Mette
M
Madsen
Rikke
R
Sørensen
Jan Kyst
JK
Madsen
Allan Zeeberg
AZ
Iversen
Hans-Henrik
HH
Tilsted
Steffen
S
Helqvist
Poul Erik
PE
Mortensen
Per Hostrup
PH
Nielsen
Eva
E
Prescott
Steen Zabell
SZ
Abildstrøm
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003718:Denmark; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D055502:Secondary Prevention; D012727:Sex Characteristics; D015996:Survival Rate; D016896:Treatment Outcome