Published Online
on December 8, 2008

A more recent version of this article appeared on December 16, 2008

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Submitted on April 30, 2008
Accepted on September 17, 2008

Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction

Hani Jneid MD^*, Gregg C. Fonarow MD, Christopher P. Cannon MD, Adrian F. Hernandez MD, Igor F. Palacios MD, Andrew O. Maree MD, Quinn Wells MD, Biykem Bozkurt MD, Kenneth A. LaBresh MD, Li Liang PhD, Yuling Hong MD, PhD, L. Kristin Newby MD, MHS, Gerald Fletcher MD, Eric Peterson MD, MPH, Laura Wexler MD, for the Get With the Guidelines Steering Committee and Investigators

From the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Tex (H.J., B.B.); University of California at Los Angeles Medical Center (G.C.F.); Thrombolysis in Myocardial Infarction Group and Brigham and Women's Hospital, Boston, Mass (C.P.C.); Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (L.L., L.K.N., A.F.H., E.P.); Massachusetts General Hospital, Boston, Mass (H.J., I.F.P., A.O.M., Q.W.); MassPro, Inc, Waltham, Mass (K.A.L.); American Heart Association National Center, Dallas, Tex (Y.H.); Mayo Clinic, Jacksonville, Fla (G.F.); and University of Cincinnati College of Medicine, Cincinnati, Ohio (L.W.).

^* To whom correspondence should be addressed. E-mail: jneid{at}bcm.tmc.edu.

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.

Methods and 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 -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.

Key words: myocardial infarction • percutaneous coronary intervention • reperfusion • revascularization • sex

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