Background: This study was undertaken to study gender differences in the use of coronary angiography (CA), revascularization (RV), and cardiovascular disease (CVD) mortality in patient with acute myocardial infarction (AMI) who were assigned to "High Indication for CA" per the American College of Cardiology/American Heart Association (ACC/ AHA) practice guidelines.
Methods and results: This is a historical prospective study based on a stratified random sample of 1165 AMI patients from January 1990 to December 1992 at seven health maintenance organization hospitals. CA was highly indicated in 286 women and 564 men. In a Cox hazard ratio (HR), women received significantly (P<.05) fewer CAs (HR, .78) and RVs (HR, .62) than men after adjusting for age, Charlson index, and congestive heart failure. Crude CVD mortality for women was higher than men (HR, 1.7). After adjustments for age, Charlson index, and congestive heart failure, the HR was reduced to 1.19 for women. Further adjustment for CA and RV lowered CVD mortality in women slightly (HR, 1.14). RV is associated with lowered CVD (HR, .41).
Conclusions: In patients with high indication for CA, use of CA and RV was significantly lower in women. After adjustments were made for risk profile and treatment modalities, women did not have a significantly increased risk for CVD compared with men. However, the apparent protective effect of RV in patients with a high indication for CA suggests that practices in line with ACC/AHA guidelines may reduce CVD in both women and men.