Observations of the Treatment of Women in the United States With Myocardial InfarctionA Report From the National Registry of Myocardial Infarction-I

Abstract

CORONARY artery disease is the leading cause of death and is responsible for more than one third of all deaths in women in the United States.¹ While the clinical manifestations of coronary artery disease in women are delayed by approximately a decade compared with men, this sex difference nearly disappears in older age.² Studies of acute myocardial infarction (AMI) from the prethrombolytic era demonstrate that women have a worse prognosis than men.^3-5 This observation has been supported by more recent large clinical trials of thrombolytic agents in both placebo and thrombolysis groups^6-10 and was emphasized recently by the GUSTO-I investigators.¹¹ This difference in outcome may be explained in part by older age, more advanced disease, higher Killip class, and a greater prevalence of underlying medical illness in women than in men.¹² Recent attention has also focused on the role of sex differences in diagnostic and therapeutic strategies in patients with known or suspected coronary artery disease. Many^13-19 but not all²⁰ studies have reported that physicians are less likely to pursue an aggressive approach in women than in men.