title: Use of diagnostic coronary angiography in women and men presenting with acute myocardial infarction: a matched cohort study.
abstract: Based on evident sex-related differences in the invasive management of patients presenting with acute myocardial infarction (AMI), we sought to identify predictors of diagnostic coronary angiography (DCA) and to investigate reasons for opting out an invasive strategy in women and men.
  
  
  
  The study was designed as a matched cohort study. We randomly selected 250 female cases from a source population of 4000 patients hospitalized with a first AMI in a geographically confined region of Denmark from January 2010 to November 2011. Each case was matched to a male control on age and availability of cardiac invasive facilities at the index hospital. We systematically reviewed medical records for risk factors, comorbid conditions, clinical presentation, and receipt of DCA. Clinical justifications, as stated by the treating physician, were noted for the subset of patients who did not receive a DCA.
  
  
  
  Overall, 187 women and 198 men received DCA within 60 days (75 % vs. 79 %, hazard ratio: 0.82 [0.67-1.00], p = 0.047).In the subset of patients who did not receive a DCA (n = 114), clinical justifications for opting out an invasive strategy was not documented for 21 patients (18.4 %). Type 2 myocardial infarction was noted in 11 patients (women versus men; 14.5 % vs. 3.8 %, p = 0.06) and identified as a potential confounder of the sex-DCA relationship. Receipt of DCA was predicted by traditional risk factors for ischaemic heart disease (family history of cardiovascular disease, hypercholesterolemia, and smoking) and clinical presentation (chest pain, ST-segment elevations). Although prevalent in both women and men, the presence of relative contraindications did not prohibit the use of DCA.
  
  
  
  In this matched cohort of patients with a first AMI, women and men had different clinical presentations despite similar age. However, no differences in the distribution of relative contraindications for DCA were found between the sexes. Type 2 MI posed a potentiel confounder for the sex-related differences in the use of DCA. Importantly,clinical justification for opting out an invasive strategy was not documented in almost one fifth of patients not receiving a DCA.
authors.affiliation: Department of Cardiology, University Hospital Gentofte, Kildegårdsvej 28, 2900, Hellerup, Denmark. louise_bjerking@hotmail.com.
authors.forename: Louise Hougesen
authors.initials: LH
authors.lastname: Bjerking
authors.affiliation: Department of Cardiology, University Hospital Bispebjerg, Copenhagen, Denmark.
authors.forename: Kim Wadt
authors.initials: KW
authors.lastname: Hansen
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Madsen
authors.affiliation: Department of Cardiology, University Hospital Gentofte, Kildegårdsvej 28, 2900, Hellerup, Denmark.|Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jan Skov
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Emergency Department, Holbaek Hospital, University of Copenhagen, Holbaek, Denmark.
authors.forename: Jan Kyst
authors.initials: JK
authors.lastname: Madsen
authors.affiliation: Department of Cardiology, University Hospital Gentofte, Kildegårdsvej 28, 2900, Hellerup, Denmark.
authors.forename: Rikke
authors.initials: R
authors.lastname: Sørensen
authors.affiliation: Department of Cardiology, University Hospital Bispebjerg, Copenhagen, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Galatius
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D003718:Denmark / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006760:Hospitalization; D006801:Humans; D008019:Life Style; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
keywords: Acute myocardial infarction; Cardiac catheterization; Coronary angiography; Gender