Gender disparity in cardiac procedures and medication use for acute myocardial infarction

Objective: Determine if gender bias is present in contemporary management of acute myocardial infarction (AMI). Background: Despite major advances in medicine, disparities in healthcare still persist. Previous studies on gender bias in the diagnosis and treatment of AMI are inconsistent and may not represent more contemporary practice. Methods and Results: Data were collected from the Minnesota Heart Survey, a population-based study of patients presenting with AMI in 2001-02. In-hospital diagnostic and therapeutic approaches were compared between women and men using logistic regression models. We identified 1242 women and 1378 men with an AMI defined by either positive cardiac biomarkers or ST-elevation on electrocardiogram. There were no differences in the prescription of aspirin, beta-blockers, ACE inhibitors or angiotensin receptor blockers. Women were 46% less likely than men to undergo investigative coronary angiography [OR = 0.54 (0.45-0.64)]. After accounting for confounders, women remained less likely to be referred for angiography [OR = 0.73 (0.57-0.94)]. Revascularization rates, were similar between women and men [OR = 0.96 (0.72-1.28)]. However, women were more likely to undergo PCI [OR = 1.41 (1.07-1.86)] whereas men were more likely to have coronary artery bypass grafting (CABG) [OR = 0.57 (0.39-0.84)]. When severity of coronary artery disease (CAD) was incorporated into the model, gender no longer influenced the modality of coronary revascularization. Conclusions: There is no evidence of gender bias in the pharmacologic treatment of AMI. Evidence of gender bias persists in the referral of patients for coronary angiography but not in the subsequent use of coronary revascularization.