Sex Differences in Use of Coronary Revascularization in Elderly Patients After Acute Myocardial Infarction

Sex Differences in Characteristics, Treatments, and In-hospital Outcomes of Patients Undergoing Coronary Angiography or Intervention

Background

Whether women have a higher risk of adverse events compared with men following coronary angiography (CAG) and percutaneous coronary intervention (PCI) remains controversial. We aimed to investigate the sex differences in characteristics, treatments and outcomes among patients undergoing CAG and PCI in a large Chinese cohort.

Methods

We analyzed patients undergoing CAG and/or PCI in this multi-center registry cohort study Cardiorenal ImprovemeNt II (CIN-II) in 5 Chinese tertiary hospitals from 2007 to 2020. Clinical characteristics, treatment (discharge medication and PCI) and in-hospital outcomes (mortality and major bleeding) were compared between women and men.

Results

Totally 141,459 patients underwent CAG (44,362 [31.4%] women), of which 69,345 patients underwent PCI (15,376 [22.2%] women). Women were older (64.4 vs. 60.8 years), had more chronic comorbidities and lower PCI rate for stable coronary artery disease (CAD) than men (52.8 vs. 64.2%). Women received less CAG and PCI procedures. Among women undergoing PCI they received similar discharge medication treatment. In addition, women undergoing PCI had mildly lower rate of major bleeding (0.2 vs. 0.3%, P = 0.033) but higher in-hospital mortality (1.2 vs. 0.8%, P < 0.001). After adjustment, women had a higher risk in the major bleeding (adjusted odds ratio, 2.04 [95% CI: 1.07 to 3.62]), and the in-hospital mortality (adjusted odds ratio, 1.87 [95% CI: 1.36 to 2.56]).

Conclusion

Among our Chinese cohort, women are older with more chronic comorbidities, receiving less PCI procedure and similar discharge medication treatment. Women have nearly 90% higher risk of in-hospital mortality and over 1-fold increased risk of major bleeding after PCI compared with men.

Practice Variation Among Hospitals in Revascularization Therapy and Its Association With Procedure-related Mortality

BACKGROUND

While substantial practice variation in coronary revascularization has been described and deviation from clinical practice guidelines has been associated with worse outcomes, the degree to which this is driven by flawed decision making and/or appropriate deviation associated with comorbid conditions is unknown. We evaluated heterogeneity in procedure use, and the extent to which hospital-level practice variation is related to surgical mortality.

METHODS

We analyzed data on 554,563 inpatients undergoing either percutaneous coronary intervention or coronary artery bypass grafting at 391 centers in 6 states. Procedure-specific risk models were developed based on demographics and comorbidities, allowing for differential effects of comorbidities for each sex. For each patient, the revascularization procedure that minimized predicted probability of inhospital mortality was designated as the model-preferred procedure.Hospital-level discordance rates-the proportion of cases in each hospital for which the opposite from the model-preferred procedure was performed-were calculated. Hierarchical linear models were used to analyze the relationship between HDRs and hospital-level risk-standardized mortality ratios (RSMRs).

RESULTS

Comorbidities and demographics alone explained between 68% and 86% of overall variation in inhospital mortality (corresponding C-statistics of 0.84-0.93). The mean (SD) HDR was 26.3% (9.6%). There was a positive independent association between HDRs and inhospital mortality, with a 10% increase in HDR associated with an 11% increase in RSMR (P<0.001).

CONCLUSIONS

Variance in procedure use according to model preference was strongly associated with worse outcomes. A systematic approach to incorporating comorbidity as part of the decision-making process for coronary revascularization is needed.

Characteristics of and outcomes for elderly patients with acute myocardial infarction: differences between females and males

Objectives

This study analyzed age-adjusted sex differences among acute myocardial infarction (AMI) patients aged 75 years and above with regard to 7-year mortality (primary end point) and the frequency of angiograms and admission to the coronary care unit (CCU) as well as 1-year mortality (secondary end points).

Methods

A retrospective cohort study comprised 1,414 AMI patients (748 females and 666 males) aged at least 75 years, who were admitted to Sahlgrenska University Hospital in Gothenburg, Sweden, during two periods (2001/2002 and 2007). All comparisons between female and male patients were age adjusted.

Results

Females were older and their previous history included fewer AMIs, coronary artery bypass grafting procedures, and renal diseases, but more frequent incidence of hypertension. On the contrary, males had higher age-adjusted 7-year mortality in relation to females (hazard ratio [HR] 1.16 with corresponding 95% confidence interval [95% CI 1.03, 1.31], P=0.02). Admission to the CCU was more frequent among males than females (odds ratio [OR] 1.38 [95% CI 1.11, 1.72], P=0.004). There was a nonsignificant trend toward more coronary angiographies performed among males (OR 1.34 [95% CI 1.00, 1.79], P=0.05), as well as a nonsignificant trend toward higher 1-year mortality (HR 1.18 [95% CI 0.99, 1.39], P=0.06).

Conclusion

In an AMI population aged 75 years and above, males had higher age-adjusted 7-year mortality and higher rate of admission to the CCU than females. One-year mortality did not differ significantly between the sexes, nor did the frequency of performed coronary angiograms.

Gender differences in health-related quality of life following ST-elevation myocardial infarction: women and men do not benefit from primary percutaneous coronary intervention to the same degree

BACKGROUND

There is limited evidence whether women benefit to the same degree as men from treatment of myocardial infarction with percutaneous coronary intervention (PCI) when compared to fibrinolysis. This study compares health-related quality of life (HRQoL) outcomes for men and women randomized to primary PCI and fibrinolysis.

DESIGN

A questionnaire-based study in 1351 patients with ST-elevation myocardial infarction (STEMI), assessed at 1 and 12 months after the infarction.

METHODS

HRQoL was measured with the Medical Outcomes Study Short Form (SF-36), the Hospital Anxiety and Depression Scale (HADS), Rose's angina and dyspnoea questionnaire and global QoL questions.

RESULTS

Women had a worse score than men on all endpoints at 1 month and at several endpoints at 12 months. In analyses of gender differences in benefits of PCI 1 month after the STEMI, significant gender differences were found in the SF-36 mental component summary scale, with men having better scores after primary PCI and women having better scores after fibrinolysis (P=0.03). At 12 months, similar gender differences in treatment benefit were found in the SF-36 scales for general health (P=0.01), mental health (P<0.01), and the mental component summary scale (P=0.01), as well as in the scales for anxiety (P=0.04), depression (P=0.02), and global quality of life (P<0.01); men had better scores after primary-PCI and women had better scores after fibrinolysis.

CONCLUSION

Compared to fibrinolysis treatment in patients with ST-elevation myocardial infarction, women do not seem to benefit from primary PCI to the same degree as men. Since previous studies have found no gender differences in clinical outcomes, this result may be specific to HRQoL.

Hormone therapy for preventing cardiovascular disease in post-menopausal women

BACKGROUND

Evidence from systematic reviews of observational studies suggests that hormone therapy may have beneficial effects in reducing the incidence of cardiovascular disease events in post-menopausal women, however the results of randomised controlled trials (RCTs) have had mixed results. This is an updated version of a Cochrane review published in 2013.

OBJECTIVES

To assess the effects of hormone therapy for the prevention of cardiovascular disease in post-menopausal women, and whether there are differential effects between use in primary or secondary prevention. Secondary aims were to undertake exploratory analyses to (i) assess the impact of time since menopause that treatment was commenced (≥ 10 years versus < 10 years), and where these data were not available, use age of trial participants at baseline as a proxy (≥ 60 years of age versus < 60 years of age); and (ii) assess the effects of length of time on treatment.

SEARCH METHODS

We searched the following databases on 25 February 2014: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE and LILACS. We also searched research and trials registers, and conducted reference checking of relevant studies and related systematic reviews to identify additional studies.

SELECTION CRITERIA

RCTs of women comparing orally administered hormone therapy with placebo or a no treatment control, with a minimum of six months follow-up.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed study quality and extracted data. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for each outcome. We combined results using random effects meta-analyses, and undertook further analyses to assess the effects of treatment as primary or secondary prevention, and whether treatment was commenced more than or less than 10 years after menopause.

MAIN RESULTS

We identified six new trials through this update. Therefore the review includes 19 trials with a total of 40,410 post-menopausal women. On the whole, study quality was good and generally at low risk of bias; the findings are dominated by the three largest trials. We found high quality evidence that hormone therapy in both primary and secondary prevention conferred no protective effects for all-cause mortality, cardiovascular death, non-fatal myocardial infarction, angina, or revascularisation. However, there was an increased risk of stroke in those in the hormone therapy arm for combined primary and secondary prevention (RR 1.24, 95% CI 1.10 to 1.41). Venous thromboembolic events were increased (RR 1.92, 95% CI 1.36 to 2.69), as were pulmonary emboli (RR 1.81, 95% CI 1.32 to 2.48) on hormone therapy relative to placebo.The absolute risk increase for stroke was 6 per 1000 women (number needed to treat for an additional harmful outcome (NNTH) = 165; mean length of follow-up: 4.21 years (range: 2.0 to 7.1)); for venous thromboembolism 8 per 1000 women (NNTH = 118; mean length of follow-up: 5.95 years (range: 1.0 to 7.1)); and for pulmonary embolism 4 per 1000 (NNTH = 242; mean length of follow-up: 3.13 years (range: 1.0 to 7.1)).We performed subgroup analyses according to when treatment was started in relation to the menopause. Those who started hormone therapy less than 10 years after the menopause had lower mortality (RR 0.70, 95% CI 0.52 to 0.95, moderate quality evidence) and coronary heart disease (composite of death from cardiovascular causes and non-fatal myocardial infarction) (RR 0.52, 95% CI 0.29 to 0.96; moderate quality evidence), though they were still at increased risk of venous thromboembolism (RR 1.74, 95% CI 1.11 to 2.73, high quality evidence) compared to placebo or no treatment. There was no strong evidence of effect on risk of stroke in this group. In those who started treatment more than 10 years after the menopause there was high quality evidence that it had little effect on death or coronary heart disease between groups but there was an increased risk of stroke (RR 1.21, 95% CI 1.06 to 1.38, high quality evidence) and venous thromboembolism (RR 1.96, 95% CI 1.37 to 2.80, high quality evidence).

AUTHORS' CONCLUSIONS

Our review findings provide strong evidence that treatment with hormone therapy in post-menopausal women overall, for either primary or secondary prevention of cardiovascular disease events has little if any benefit and causes an increase in the risk of stroke and venous thromboembolic events.

Sex preferences in cardiovascular testing: the contribution of the patient-physician discussion

OBJECTIVES

Prior studies suggest that a decreased cardiac catheterization rate for women with acute coronary syndrome (ACS) is partially attributed to gender differences in patient preferences for testing. The hypothesis was that these preferences are influenced by physician recommendations for cardiovascular testing.

METHODS

This was a cohort study of patients who presented to an emergency department (ED) with chest pain. At the time of ED disposition, patients were surveyed to assess whether or not the doctor discussed the possibility of coronary artery disease (CAD), the physician's recommendations for diagnostic testing, and the patient's preferences for further testing. The survey was repeated at the time of discharge from the hospital if the patient was admitted and again at 30 days for all patients. The main outcome was patient-reported physician recommendation for testing, and the secondary outcome was patient preference for cardiovascular testing.

RESULTS

There were 206 patients enrolled (118 women, 88 men). Women were less likely than men to receive cardiac catheterization as inpatients (9.8% vs. 20.0%, p = 0.04). In the ED, women were less likely to be recommended for stress testing (8.5% vs. 19.3%, p = 0.02) or cardiac catheterization (4.2% vs. 13.6%, p = 0.02) or to see a cardiologist (8.5% vs. 22.7%, p < 0.01). As inpatients, women were more likely to be told that no further testing was needed (70.5% vs. 50.0%, p = 0.03). While there was higher incidence of prior CAD and myocardial infarction among the men in the study, analysis after removal of these patients did not alter results. Physicians were less likely to counsel women about diagnostic testing options in the ED (10.1% vs. 22.7%, p = 0.03), as inpatients (11.5% vs. 40.0%, p < 0.01), and as outpatients (26.1% vs. 48.6%, p = 0.04). No patients in the study refused their doctors' recommendations. Women were less likely to prefer catheterization in the ED (5.1% vs. 15.9%, p = 0.01) and were more likely to prefer no further testing as inpatients (60.7% vs. 40.0%, p = 0.02).

CONCLUSIONS

Women who presented to the ED with symptoms concerning for ACS reported lower rates of physician recommendation for cardiovascular testing, as well as lower rates of counseling regarding cardiac etiologies of their chest pain. These findings suggest sex differences in preference for cardiovascular testing may be partially explained by the discussions between women and their doctors.

Contemporary clinical outcomes of primary percutaneous coronary intervention in elderly versus younger patients presenting with acute ST-segment elevation myocardial infarction

BACKGROUND

Primary percutaneous coronary intervention (PPCI) is the choice reperfusion strategy for acute ST-segment elevation myocardial infarction (STEMI). However, data on PPCI in elderly patients are sparse. This study determined clinical outcome post-PPCI in elderly versus younger patients with STEMI.

METHODS AND RESULTS

 A cohort of 790 consecutive STEMI patients was studied for survival and major adverse cardiovascular events (MACE) after PPCI using a precise cardiac catheterization protocol. Patients were divided into two groups: those ≥75 years (elderly) and those <75 years. Median door-to-balloon time (DBT) was 82 minutes in the elderly versus 66 minutes in the younger group (P = 0.002). In-hospital all-cause mortality was higher in the elderly group (15.5% vs. 2.7%, P < 0.001). In elderly patients, MACE were found to be higher (32.3% vs. 16.1%, P < 0.001). Using a multivariate logistic regression analysis, age (odds ratio [OR]= 1.04, 95% confidence interval [CI]= 1.02-1.05, P < 0.001), diabetes (OR = 2.17, 95% CI = 1.33-3.53, P = 0.002), renal failure (OR = 3.75, 95% CI = 1.30-10.79, P = 0.014) and coronary artery disease (OR = 1.61, 95% CI = 1.00-2.59, P = 0.050) were associated with higher in-hospital MACE, while age (OR = 1.05, 95% CI = 1.02-1.08, P = 0.001), diabetes (OR = 2.18, 95% CI = 1.06-4.47, P = 0.034) and renal failure (OR = 6.65, 95% CI = 2.01-22.09, P = 0.002) were associated with higher in-hospital mortality. Kaplan-Meier 1-year survival rate was lower in the elderly.

CONCLUSIONS

 In a contemporary population of STEMI patients treated with PPCI, overall in-hospital MACE and mortality remain higher in elderly compared to younger patients. Although partly due to higher burden of preexisting comorbidities, a higher DBT may also be responsible. (J Interven Cardiol 2011;24:357-365).

Sex bias in cardiovascular testing: the contribution of patient preference

STUDY OBJECTIVE

Women with potential acute coronary syndromes are less likely to receive cardiac catheterization or revascularization than men. We hypothesize that this may be due to different diagnostic test preferences of female and male patients.

METHODS

We conducted a cohort study at 4 emergency departments enrolling patients who presented with symptoms of potential acute coronary syndromes. After hearing the potential benefits and harms of each test, subjects completed a 21-item survey assessing their preference for noninvasive testing versus cardiac catheterization. Based on hypothetical test results, similar questions about medical versus interventional management were asked. Subjects were also queried about likelihood of following physician recommendation for each test or intervention. Actual 30-day testing and interventions were recorded. The main outcome was patient preference about each procedure and the likelihood of patient saying they would accept the physician recommendation.

RESULTS

One thousand eighty patients enrolled; 652 (60%) were admitted to the hospital. With regard to diagnostic test preference, both women and men preferred stress test to catheterization (women 58% versus men 52%; difference 6% [95% confidence interval {CI} -0.06% to 12%]), and the proportion of women and men who would accept the physician recommendation for stress tests was similar (85% for both); however, the stated acceptance rate for cardiac catheterization was lower for women (65% versus 75%; difference -10% [95% CI -15% to -4%]). Women were 6% less likely (67% versus 73%; 95% CI for difference 12% to 0.5%) to accept percutaneous coronary intervention over medical therapy and 7% less likely (61% versus 68%; 95% CI for difference -13% to 1%) to desire coronary artery bypass grafting over medical therapy. The survey results are consistent with the patients' clinical course. During the initial hospitalization, women were less likely to receive diagnostic testing of any type (38% versus 45%; difference -7%; 95% CI for the difference -13% to -1.5%) and cardiac catheterization (10% versus 17%; difference -7% [95% CI -11% to -2%]). Revascularization was infrequent in both groups (4% versus 6%; difference -2% [95% CI -5% to 0.6%]).

CONCLUSION

Although women and men had similar preferences about cardiac diagnostic tests and treatment options, women were less likely than men to say they would accept the physician recommendation for any intervention. Patient preference may partially explain the disparity in cardiovascular testing between women and men.

Coronary artery bypass grafting within the first year after treatment of large acute myocardial infarctions with angioplasty or fibrinolysis

OBJECTIVES

To calculate the incidence and analyse and outcome after coronary artery bypass grafting (CABG) within the first year after randomisation of 1,572 patients with acute myocardial infarctions with ST-segment elevation (STEMI) to either percutaneous coronary intervention (PCI) or fibrinolysis.

DESIGN

The study includes 131 patients: 108 male and 23 female with a mean age 62 years.

RESULTS

The total 30-day mortality after CABG was 4.6% (7.5% in the PCI group and 2.6% in the fibrinolysis group). The 30-day mortality was 9.8% after CABG within the first 30-days and 1.3% after CABG within 31-365 days. The patients who were operated early had a reduced EF to 43% as compared to 50% in patients who were not operated or patients having CABG after 30-days (p=0.002).

CONCLUSION

CABG was performed within the first year after STEMI in 10% of patients randomised to fibrinolysis and in 6.7% of patients randomised to PCI. Patients having CABG within the first 30-days after treatment of STEMI had an increased mortality of 9.8%.

Quality of care in elder emergency department patients with pneumonia: a prospective cohort study

Background

The goals of the study were to assess the relationship between age and processes of care in emergency department (ED) patients admitted with pneumonia and to identify independent predictors of failure to meet recommended quality care measures.

Methods

This was a prospective cohort study of a pre-existing database undertaken at a university hospital ED in the Midwest. ED patients ≥18 years of age requiring admission for pneumonia, with no documented use of antibiotics in the 24 hours prior to ED presentation were included. Compliance with Pneumonia National Quality Measures was assessed including ED antibiotic administration, antibiotics within 4 hours, oxygenation assessment, and obtaining of blood cultures. Odds ratios were calculated for elders and non-elders. Logistic regression was used to identify independent predictors of process failure.

Results

One thousand, three hundred seventy patients met inclusion criteria, of which 560 were aged ≥65 years. In multiple variable logistic regression analysis, age ≥65 years was independently associated with receiving antibiotics in the ED (odds ratio [OR] = 2.03, 95% CI 1.28–3.21) and assessment of oxygenation (OR = 2.10, 95% CI, 1.18–3.32). Age had no significant impact on odds of receiving antibiotics within four hours of presentation (OR 1.10, 95% CI 0.84–1.43) or having blood cultures drawn (OR 1.02, 95%CI 0.78–1.32). Certain other patient characteristics were also independently associated with process failure.

Conclusion

Elderly patients admitted from the ED with pneumonia are more likely to receive antibiotics while in the ED and to have oxygenation assessed in the ED than younger patients. The independent association of certain patient characteristics with process failure provides an opportunity to further increase compliance with recommended quality measures in admitted patients diagnosed with pneumonia.

Understanding sex differences in health-related quality of life following myocardial infarction

BACKGROUND

The role of sex differences in health-related quality of life (HRQoL) after myocardial infarction (MI) remains controversial.

METHODS

In total 408 Norwegian patients completed the Short Form 36 (SF-36) questionnaire 2.5 years after MI. We compared HRQoL between sexes and with national norms. Multiple linear regression analysis was used to explore the association of scores on the Physical (PCS) and Mental (MCS) component summary scales with clinical and sociodemographic variables.

RESULTS

Women scored lower than norms on the Physical functioning, Role functioning-physical, General health, and Role functioning-emotional scales. Men scored higher on Bodily pain, and lower on the other 7 scales compared to norms. Women <70 years scored lower than men on 3 out of 8 scales and on PCS. Women >/=70 scored lower than men on 5 out of 8 scales and on PCS. Relative to sex- and age-specific norms, there were no sex-differences in SF-36 scores. Age, time since the index MI, chronic obstructive pulmonary disease (COPD), previous MI, and stroke predicted PCS scores in women. Education, COPD, infarct localization, number of indications for cardiovascular medication at discharge, medication for heart failure, and subsequent MI predicted PCS scores in men. Smoking status, education, and Q-wave MI were determinants for MCS scores in men.

CONCLUSION

Patients had impaired HRQoL compared to sex- and age-specific norms 2.5 years after MI. Women had lower HRQoL scores than men, but relative to norms HRQoL was equally affected in both sexes. Men and women had different determinants of HRQoL.

Are patients with coexisting mental disorders more likely to receive CABG surgery from low-quality cardiac surgeons? The experience in New York State

BACKGROUND

Presence of a mental disorder has been shown to be associated with reduced access to medical and surgical services. Little is known, however, about the relationship between mental disorders and the quality of medical/surgical care received.

METHODS

We analyzed New York State hospital discharge data between 2001 and 2003 and New York's publicly-released Cardiac Surgery Report of surgeons' risk-adjusted mortality rate, to evaluate whether differences exist between persons with and without mental disorders (specifically, psychiatric and/or substance-use disorders) in receiving care from low-quality and high-quality surgeons performing coronary artery bypass graft (CABG) surgeries.

RESULTS

Controlling for individual demographic, socioeconomic, and clinical characteristics, persons with any mental disorder (n = 3211) were more likely than others (n = 36,628) to be treated by low-quality cardiac surgeons (odds ratio [OR] = 1.28, P = 0.023), whose reported risk-adjusted mortality rates were significantly higher than the state average CABG mortality rate. Compared with patients without mental disorders, patients with psychiatric disorders (n = 2651) showed an increased likelihood of being treated by these low-quality surgeons (OR = 1.36, P = 0.008). In addition, patients with both substance-use and psychiatric disorders (n = 113), but not substance-use alone (n = 447), were more likely to receive care from surgeons in the high-mortality quintile group (OR = 1.76, P = 0.024). There was no significant association between each type of mental disorders and the likelihood of being treated by a low-mortality, high-quality cardiac surgeon.

CONCLUSIONS

New York State patients with mental disorders, especially psychiatric disorders, are more likely to receive CABG surgery from low-quality cardiac surgeons. No evidence suggests that these patients are disadvantaged in access to high-quality cardiac surgeons.

Gender Differences in Treatment of Heart Failure and Acute Myocardial Infarction

Recent articles have inquired about the quality of care for women presenting with cardiovascular disease. The Cooperative Cardiovascular Project and the National Heart Failure Project, 2 Medicare databases, provide national data to address concerns that women receive poorer quality care than men. In these databases, sex was not independently associated with the use of beta-blockers, assessment of left ventricular ejection fraction, or use of fibrinolytic therapy for acute myocardial infarction (MI), nor of angiotensin-converting enzyme (ACE) inhibitor prescription for heart failure. Women with MI were slightly less likely to receive aspirin and slightly more likely to receive ACE inhibitors. Among patients with equivocal indications, men were significantly more likely than women to undergo cardiac catheterization, whereas there were no sex differences among patients with strong indication. Women were more likely than men to undergo percutaneous coronary intervention and less likely to receive coronary artery bypass graft surgery. Short-term mortality rates after MI and readmission rates after heart failure did not vary significantly by gender; however, risk of mortality after heart failure was slightly lower for women. Within multivariate models, gender differences in treatment were small and in many cases insignificant. These national datasets fail to reveal a strong sex bias in treatment among patients aged > or = 65 years.

Differences in in-hospital mortality between men and women with acute myocardial infarction undergoing percutaneous coronary intervention in Japan: Tokai Acute Myocardial Infarction Study (TAMIS)

BACKGROUND

It is a matter of concern that women have higher in-hospital mortality rates than men with percutaneous coronary intervention (PCI); however, it is not yet clear whether significant sex differences exist. This study aimed to determine if there are sex differences in the characteristics and in-hospital mortality among patients with acute myocardial infarction (AMI) undergoing PCI in Japan.

METHODS

We used data from 13 acute care hospitals in the Tokai region (central Japan) included in the sample from the TAMIS, a retrospective study of all patients admitted to these hospitals from 1995 to 1997 with a diagnosis of AMI. We abstracted the baseline and procedural characteristics from detailed chart reviews which included not only physician notes but also nursing notes, and a questionnaire included baseline characteristics, procedural course, and in-hospital mortality. Multivariate analysis was performed, controlling for age and other variables which were found to be significantly different between men and women by chi2 test or Mann-Whitney U test.

RESULTS

In TAMIS, we had a total of 2020 subjects. A total of 303 women and 1033 men undergoing PCI were included in the present study. There were sex differences in age, comorbid conditions, smoking status, activities of daily living, and heart failure on presentation. In univariate analysis, women had a higher in-hospital mortality rate than men; however, this sex difference disappeared after multivariable adjustment.

CONCLUSIONS

Our study demonstrates that women with AMI who undergo PCI do not have a significantly higher in-hospital mortality rate than men in Japan; additional larger-scale studies are needed to confirm these results.

Age-related differences in the delivery of cardiac management to women versus men with acute myocardial infarction in Japan: Tokai Acute Myocardial Infarction Study: TAMIS

It is of concern that women are more likely to undergo fewer diagnostic tests and receive less treatment for acute myocardial infarction (AMI) than men. However, it is still unclear whether gender differences exist according to age groups. Therefore, we studied the influence of gender on the delivery of cardiac management according to two age groups (< 65, >or= 65) in Japan. Data from the Tokai Acute Myocardial Infarction Study (TAMIS) sample were used. This is a retrospective study of all consecutive patients admitted to the 13 acute care hospitals in the Tokai region of Japan, which includes Aichi and Shizuoka Prefectures, with a diagnosis of AMI from 1995 to 1997. A total of 143 younger women, 822 younger men, 391 older women, and 611 older men were included. Information concerning patient demographics, in-hospital course, comorbid conditions, electrocardiography (ECG), ultrasound-echocardiography (UCG), treadmill test (TMT), coronary angiography (CAG), percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG), intra-aortic balloon pump (IABP), mechanical ventilation, and in-hospital or discharge medication (thrombolytics, vasopressors, aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium antagonists, nitrates) were collected. Among the young, after controlling for these baseline variables, women were significantly less likely to undergo PTCA compared to men (OR, 0.54, 95%CI, 0.35-0.82). After controlling for these baseline variables, only lipid-lowering therapy tended to be more frequent in women than in men among the elderly (OR, 2.79, 95%CI, 1.47-2.58). The findings suggest that younger women with AMI are less likely than younger men to undergo PTCA, and that older women with AMI are more likely to receive lipid-lowering therapy.

Age Differences in the Delivery of Cardiac Management to Women Versus Men With Acute Myocardial Infarction An Evaluation of the TAMIS-II Data

It is of concern that women are more likely to undergo fewer diagnostic tests and receive less treatment for acute myocardial infarction (AMI) than men. Our retrospective Tokai Acute Myocardial Infarction Study (TAMIS) indicated that there were gender differences according to age groups; however, the exact nature of these gender differences remains unclear. Therefore, using data from TAMIS-II, we studied the influence of gender on the delivery of cardiac management according to 2 age groups (< 65, >or= 65). TAMIS-II is a prospective study of all consecutive patients admitted to the 15 acute care hospitals in the Tokai region with the diagnosis of AMI from 2001 to 2003. A total of 169 younger women, 1246 younger men, 616 older women, and 1240 older men were included. Data on patient demographics, in-hospital course, comorbid conditions, electrocardiography (ECG), ultrasound-echocardiogram (UCG), treadmill test (TMT), coronary angiography (CAG), percutaneous coronary intervention (PCI), coronary artery bypass grafts (CABG), intra-aortic balloon pump (IABP), mechanical ventilation, and in-hospital or discharge medications (thrombolytics, vasopressors, aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium antagonists, nitrates) were collected. After controlling for these baseline variables, only lipid-lowering therapy tended to be more frequent in women than in men among the elderly (OR 1.55, 95%CI 1.00-2.38). The results from this Japanese chart review study, derived from detailed clinical data, indicated that the delivery pattern of cardiac management for female and male AMI patients during hospitalization and at discharge was very similar among the younger and older populations.