title: In-hospital outcomes and long-term mortality according to sex and management strategy in acute myocardial infarction. Insights from the French ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 Registry.
abstract: BACKGROUND
  The early mortality of acute myocardial infarction (AMI) has dramatically decreased in the recent past. Whether the previously reported sex disparities in use of invasive strategies (IS) persist and translate into differences in outcomes deserves to be examined.
  
  
  METHODS
  We used the data from a nationwide French prospective multicentre registry from 3,670 AMI patients (1155 women (31.5%), 2515 men (68.5%)) recruited in 223 centres in 2005 and followed-up for 5 years. We examined in-hospital outcomes and 5-year mortality in patients categorized according to sex and use of IS (i.e. coronary angiography during the hospitalisation with a view to revascularisation).
  
  
  RESULTS
  IS was less frequently used in women than in men (adjusted OR=0.66; 95% CI: 0.52-0.85), regardless of the type of AMI, age group or risk category, while use of recommended medications was similar at 48 hours and discharge. In-hospital mortality did not differ according to sex, whatever the age group and use of an IS. At 5 years, overall and post-discharge mortality were similar in men and women. However, IS was associated with lower 5-year mortality in women (HR=0.66; 95% CI: 0.51-0.86) as in men (HR=0.48; 95% CI: 0.38-0.60) and there was no sex-strategy interaction.
  
  
  CONCLUSIONS
  Invasive strategy remains less frequently used in women than in men, yet is associated with improved five-year survival irrespective of sex. Whether reducing the sex gap in its use would translate into a higher survival in women remains an open question.
  
  
  BACKGROUND
  NCT 00673036.
authors: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Paris, France; Université Paris-Descartes, Paris France.
authors: Maria Pia
authors: MP
authors: Donataccio
authors: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Paris, France; Université Paris-Descartes, Paris France; INSERM U-970, Paris, France. Electronic address: etiennepuymirat@yahoo.fr.
authors: Etienne
authors: E
authors: Puymirat
authors: Division of Cardiology, Clinical Center of Serbia, Belgrade University School of Medicine, Belgrade, Serbia.
authors: Biljana
authors: B
authors: Parapid
authors: AP-HP, Hôpital Bichat, Department of Cardiology, Paris, France; Université Paris Diderot-Paris VII, France; INSERM, U-698, Paris, France.
authors: Philippe Gabriel
authors: PG
authors: Steg
authors: Hôpital Charles Nicolle, Department of Cardiology, Rouen, France; University of Rouen, France.
authors: Hélène
authors: H
authors: Eltchaninoff
authors: Université Paris-Descartes, Paris France; AP-HP, Hôpital Cochin, Department of Cardiology, Paris, France.
authors: Simon
authors: S
authors: Weber
authors: Pasteur Hospital, Department of Cardiology, University Hospital of Nice, Nice, France.
authors: Emile
authors: E
authors: Ferrari
authors: Valenciennes General Hospital, Department of Cardiology, Valenciennes, France.
authors: Didier
authors: D
authors: Vilarem
authors: Purpan University Hospital, Emergency Department, Toulouse, France; U1027, INSERM, France.
authors: Sandrine
authors: S
authors: Charpentier
authors: AP-HP, Hôpital Lariboisière, Department of Cardiology, Paris, France.
authors: Stéphane
authors: S
authors: Manzo-Silberman
authors: Toulouse Rangueil University Hospital, Department of Cardiology, France; UMR1027, INSERM, France.
authors: Jean
authors: J
authors: Ferrières
authors: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Paris, France; Université Paris-Descartes, Paris France.
authors: Nicolas
authors: N
authors: Danchin
authors: AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology, Paris, France; INSERM, U-698, Inserm, Paris, France; UPMC-Paris 06, France.
authors: Tabassome
authors: T
authors: Simon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D019468:Disease Management; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D009204:Myocardial Revascularization / Q000379:methods*; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute myocardial infarction; Coronary angiography; Invasive strategy; Mortality; Sex