title: Frequency of coronary angiography and revascularization among men and women with myocardial infarction and their relationship to mortality at one year: an analysis of the Geisinger myocardial infarction cohort.
abstract: OBJECTIVE
  To determine sex bias in the selection of strategies to evaluate patients with acute myocardial infarction (AMI), and determine if the choice of strategy influences survival.
  
  
  BACKGROUND
  Controversy exists regarding the role of female sex in the use of invasive evaluation for AMI and its possible effect on adverse outcomes.
  
  
  METHODS
  Electronic health record data from the Geisinger Acute Myocardial Infarction Cohort (GAMIC) was analyzed which included 1,968 men and 1,047 women admitted to the Geisinger Medical Center between January 2001 and December 2006 with acute myocardial infarction (AMI).Multivariate logistic regression analyses were used to determine independent correlates of an invasive evaluation. Multivariate logistic regression modeling stratified on sex was used to determine when invasive evaluation was done and whether there was a correlation with mortality.
  
  
  RESULTS
  In unadjusted analyses, male sex was a significant predictor for the use of invasive evaluation (odds ratio = 1.71, 95% CI = [1.46, 2.00]). Adjusted for baseline differences (like age, renal function, co-morbid conditions) multivariate analyses found no significant relationship between male sex and invasive evaluation (OR = 1.02, 95% CI = [0.82, 1.23]). Females in the STEMI group were found to be less revascularized. No difference was observed in the one-year mortality between women and men regardless of invasive evaluation or revascularization.
  
  
  CONCLUSIONS
  Sex was not independently associated with the occurrence of an invasive evaluation of a MI. Females in the STEMI group were less revascularized. There was no strong gender effect on survival irrespective of the performance on an invasive evaluation or revascularization.
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania, USA. kaskelding@geisinger.edu
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Skelding
authors.forename: Gouthami
authors.initials: G
authors.lastname: Boga
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sartorius
authors.forename: G Craig
authors.initials: GC
authors.lastname: Wood
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.forename: Vernon H
authors.initials: VH
authors.lastname: Mascarenhas
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Good
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Scott
authors.forename: James C
authors.initials: JC
authors.lastname: Blankenship
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D004363:Drug Utilization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D010414:Pennsylvania; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D019039:Platelet Glycoprotein GPIIb-IIIa Complex