Observations of the Treatment of Women in the United States With Myocardial Infarction<subtitle>A Report From the National Registry of Myocardial Infarction-I</subtitle>

Relation of Race and Sex to the Use of Reperfusion Therapy in Medicare Beneficiaries with Acute Myocardial Infarction

“…Thrombolytic therapy is the most common method used to restore flow, 2 and primary angioplasty has been accepted as an alternative method of reperfusion. [3][4][5] However, there is increasing evidence that reperfusion may be underused among blacks, 6-8 women, [9][10][11][12][13][14] and the elderly. [15][16][17] The effect of race on the risk and incidence of ischemic heart disease and its associated mortality differs between men and women.…”

Age Difference Explains Gender Difference in Cardiac Intervention Rates After Acute Myocardial Infarction

“…Although the combined number of deaths from heart disease and stroke is now equal between males and females in Canada (Heart and stroke foundation of Canada 2007;statistics Canada 2007), there are still more acute myocardial infarctions (AmIs) among males, and males experience AmIs at younger ages than females (Chandra et al 1998;Alter et al 2002;Bertoni et al 2004;Tu et al 2003;shaw et al 2004;Williams et al 2004;vaccarino et al 2005;Anand et al 2005;fang and Alderman 2006). However, these differences have not always been adequately controlled for in studies of treatment rates, resulting in conflicting evidence about the existence of a gender bias in clinical care after AmI.…”

In reply

“…In the National Registry of Myocardial Infarction-1 study, a database of 354,435 patients, women were less likely to receive cardiac catheterization and PCI. 2 Blomkalns et al 3 reported higher cardiac catheterization and revascularization in men, but revascularization was performed in equal proportions of patients with significant coronary disease. However, women waited longer for invasive diagnostic and therapeutic interventions.…”

“…1,2 This discussion, however, suffers from being out of date. We write to update the information provided in the editorials as well as to call the attention of the emergency medicine community to the latest problems created by these core measures.…”