Treatment and outcome in acute myocardial infarction in a community in relation to gender

Aim

To describe treatment and outcome in all patients in a community with acute myocardial infarction (AMI) in relation to gender.

Methods

All patients discharged from hospital between 2001 and 2002 in Göteborg, Sweden, with a diagnosis of AMI underwent a survey to find possible gender differences. All p-values are age adjusted.

Results

Among 1423 admissions, women comprised 41% and were older than men (mean 79 versus mean 72 years). Women were admitted to a coronary care unit less frequently than men (49% versus 67%; p=0.005). Women underwent coronary angiography less frequently (21% versus 40%; p=0.02). Percutaneous coronary intervention (PCI) was performed in 10% of the women and 18% of the men (p=0.36). Coronary artery bypass grafting (CABG) was performed in 2% of the women and in 9% of the men (p<0.0001).

Female gender was associated with a lower risk of reinfarction during first year after hospital discharge (12% versus 16%; p=0.003). The cumulative three-year mortality was 49% in women and 41% in men. However, when adjusting for age, admittance to CCU, coronary angiography and coronary revascularisation, risk of death during 3 years was lower in women than men (odds ratio 0.72; 95% confidence interval 0.60–0.85; p=0.0001).

Conclusion

In the community of Göteborg women (mean age 79 years) with AMI are prioritised differently than men (mean age 72 years), prior to admission to a CCU. This results in a less invasive strategy in women, particularly with regard to CABG. When adjusting for difference in age, admittance to CCU and coronary revascularisation female gender was associated with a low risk of death during the subsequent 3 years.