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A Report From the National Registry of Myocardial Infarction-I

Nisha C. Chandra, MD; Roy C. Ziegelstein, MD; William J. Rogers, MD; Alan J. Tiefenbrunn, MD; Joel M. Gore, MD; William J. French, MD; Michael Rubison, PhD; for the National Registry of Myocardial Infarction-I

Arch Intern Med. 1998;158:981-988.

Background  To determine whether there are sex differences in the demographics, treatment, and outcome of patients with acute myocardial infarction in the United States, data from the National Registry of Myocardial Infarction-I from September 1990 to September 1994 were examined.

Methods  The National Registry of Myocardial Infarction-I is a national observational database consisting of 1234 US hospitals in which each hospital submits data from each patient with acute myocardial infarction to a central data collection center. For these analyses, the following variables were examined in 354435 patients with acute myocardial infarction: demographics; use of medical therapy including thrombolytic agents; use of procedures including cardiac catheterization, percutaneous transluminal coronary angioplasty, and coronary artery bypass surgery; length of hospital stay; adverse events (stroke, major bleeding, or recurrent myocardial infarction); and causes of death.

Results  In comparison with men, women experiencing acute myocardial infarction in the United States are older, with 55.7% older than 70 years. Women have a higher mortality rate than men even when controlled for age and die less often from arrhythmia but more often from cardiac rupture whether or not thrombolytic therapy is used. Treatment with aspirin, heparin, or -blockers is less frequent in women. When thrombolytic therapy is used, women are treated an average of almost 14 minutes later than men and experience a greater incidence of major bleeding. Cardiac catheterization, percutaneous transluminal coronary angioplasty, and coronary artery bypass surgery are used less often in women.

Conclusions  Observations from the National Registry of Myocardial Infarction-I document important sex differences in demographics, treatment, and outcome of patients with acute myocardial infarction in the United States.

From the Johns Hopkins University School of Medicine, Baltimore, Md (Drs Chandra and Ziegelstein); University of Alabama Medical Center, Birmingham (Dr Rogers); Washington University School of Medicine, St Louis, Mo (Dr Tiefenbrunn); University of Massachusetts Medical Center, Worcester (Dr Gore); Harbor-University of California, Los Angeles, Medical Center, Torrance (Dr French); and ClinTrials Research Inc, Lexington, Ky (Dr Rubison). A list of participants in the National Registry of Myocardial Infarction-I is available from ClinTrials Research Inc.

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