Gender differences of revascularization in patients with acute myocardial infarction

Women are less likely to undergo revascularization after acute myocardial infarction (AMI). We assessed whether this was due to patterns of hospital admission or less frequent revascularization even when resources are available. Using New York City hospital discharge records from 1995 to 2002, we determined revascularization rates for patients who were hospitalized for AMI. Rates of admission to hospitals capable of revascularizing and revascularization use were assessed by gender. Odds ratios of admission and procedure use were determined after adjusting for sociodemographic and clinical characteristics and accounting for availability of revascularization in neighborhoods of residence. Of 93,978 patients with AMI (43.7% women), 27% were revascularized (32% and 20% for men and women, respectively, p <0.001). Moreover, women were less likely than men to be admitted to hospitals capable of revascularization (45% vs 52%, p <0.001) and to undergo revascularization (54% vs 60%, p <0.001) when admitted to capable hospitals. These differences were similar for residents of neighborhoods with or without revascularization services. Odds ratios for men versus women were 1.22 (95% confidence interval 1.18 to 1.26) for admission to revascularizing hospitals and 1.28 (95% confidence interval 1.22 to 1.34) for using revascularization among patients in revascularization hospitals. The in-hospital mortality advantage of men over women persisted after revascularization (9.6% vs 14.5%). In conclusion, less revascularization after AMI among women was associated with less frequent admission to hospitals capable of revascularization and less frequent revascularization even when admitted to performing hospitals. However, improving revascularization among women does not eliminate the gender disparity of in-hospital death after AMI.