Clinical InvestigationAcute Ischemic Heart DiseaseGender disparity in cardiac procedures and medication use for acute myocardial infarction
Section snippets
Data sources
The MHS is an ongoing cross-sectional study designed to describe population trends in cardiovascular diseases of patients age 30 and older residing in the Minneapolis-St. Paul metropolitan area (2000 Census: 2.6 million). Details of the methods are described in prior publications.11 This analysis was based on the most recent survey, performed on patients discharged between July 1, 2001 and June 30, 2002, with a discharge diagnosis of AMI. Data abstraction from hospital medical records was
Results
During the study period, the MHS registry abstracted data on 3019 subjects treated for AMI. From this sample, 368 (12%) subjects developed an AMI while hospitalized for a non-cardiac cause and were excluded. An additional 31 (1%) subjects failed to meet validation criteria for AMI, leaving 2,620 subjects — 1242 women and 1378 men — in our study sample.
Discussion
In an era of evidence-based guidelines and quality improvement initiatives, one might not expect gender to play a role in the assessment and management of cardiovascular disease. To the contrary, we observed evidence of gender bias in specific aspects of AMI care. While presenting symptoms varied by gender, there were no significant differences in either the ECGs or the proportion of positive cardiac biomarkers. Gender did not influence the pharmacologic therapy of AMI. The primary influence of
Conclusions
While we found no evidence of a gender bias in pharmacologic therapy or revascularization, our study revealed gender bias was present in the use of diagnostic cardiac angiography. Gender also influenced coronary reperfusion modality — favoring PCI for women and CABG for men. However, this differential utilization in revascularization therapies reflected, in part, the more severe CAD pattern observed in men. When disease severity was considered, the disparity in care strategy was no longer
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Disclosures: JTN received support from the Ruth Kirschstein National Research Service Award.