Circulation, Vol 90, 1715-1730, Copyright © 1994 by American Heart Association
JB Kostis, AC Wilson, K O'Dowd, P Gregory, S Chelton, NM Cosgrove, A Chirala and T Cui
BACKGROUND: We wished to evaluate whether differences in the rate of
invasive cardiac procedures between men and women with acute myocardial
infarction are associated with different short- and long-term mortality.
METHODS AND RESULTS: The database (Myocardial Infarction Data Acquisition
System, MIDAS) included all discharges for the years 1986 and 1987 with the
diagnosis of acute myocardial infarction in New Jersey, based on the New
Jersey hospital discharge data system (MIDS/UB- 82). Accuracy of the data
was evaluated by auditing 726 randomly selected charts. The variables
examined included age, sex, race, comorbidity (anemia, chronic liver
disease, cancer, chronic obstructive pulmonary disease, diabetes,
hypertension, prior myocardial infarction), complications (left ventricular
dysfunction, arrhythmias, conduction defects), insurance status,
performance of cardiac catheterization, percutaneous transluminal coronary
angioplasty, or coronary artery bypass graft surgery, and survival up to 3
years. Women were older, had longer hospital stay, and were more likely
than men to have anemia, diabetes, hypertension, left ventricular
dysfunction, and Medicare or Medicaid insurance coverage. They were less
likely than men to be admitted to a hospital equipped to perform invasive
procedures or to have chronic obstructive pulmonary disease, chronic liver
disease, prior myocardial infarction, or arrhythmias. After adjustment for
these differences, women were less likely than men to have cardiac
catheterization. Cardiac catheterization was associated with lower
mortality. Women up to age 70 had higher 3-year death rates than men after
adjustment for age, race, comorbidity, complications, and insurance type.
This difference between men and women was somewhat diminished after the
performance of cardiac catheterization and revascularization was taken into
account. Unadjusted mortality was high in this study group. CONCLUSIONS:
Women with acute myocardial infarction are less likely to have invasive
cardiac procedures and have higher 3-year adjusted death rate up to age 70
than men.
ARTICLES
Sex differences in the management and long-term outcome of acute myocardial infarction. A statewide study. MIDAS Study Group. Myocardial Infarction Data Acquisition System
UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903-0019.
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