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Clinical Investigations: CARDIOLOGY |

Influence of Age on Gender Differences in the Management of Acute Inferior or Posterior Myocardial Infarction*

Manuel Martínez-Sellés, MD, PhD; Ramón López-Palop, MD, PhD; Esther Pérez-David, MD, PhD; Héctor Bueno, MD, PhD
Author and Funding Information

*From the Department of Cardiology (Drs. Martínez-Sellés, Pérez-David, and Bueno), Hospital General Universitario “Gregorio Marañón,” Madrid; and Hospital Universitario Virgen de la Arrixaca (Dr. López-Palop), Murcia, Spain.

Correspondence to: Héctor Bueno, MD, PhD, Department of Cardiology, Hospital General Universitario “Gregorio Marañón,” Dr. Esquerdo, 46. 28007, Madrid, Spain; e-mail: hecbueno@jet.es



Chest. 2005;128(2):792-797. doi:10.1378/chest.128.2.792
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Study objectives: To assess the effect of gender on the in-hospital management of patients with acute inferior or posterior myocardial infarction (MI).

Design: Retrospective analysis of clinical records. Gender differences in management and prognosis were assessed by stepwise multiple logistic regression analysis.

Setting: University, large-volume, tertiary hospital.

Patients: We studied 1,178 consecutive patients admitted to our coronary care unit with an acute inferior or posterior MI, and evaluated the influence of gender on clinical management and outcome.

Interventions: None.

Measurements and results: Women were older (73 years vs 66 years), had a higher prevalence of diabetes and hypertension, presented later (8 h vs 6 h after symptom onset), and had a higher in-hospital mortality rate (26% vs 9%) [all p values < 0.01]. Women underwent reperfusion therapy (45% vs 61%, p < 0.01), noninvasive studies (30% vs 62%, p < 0.001), and coronary angiography (34% vs 48%, p < 0.01) less often than men. Multivariable analysis revealed that female gender was an independent predictor of a lower use of noninvasive studies (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.24 to 0.63; p < 0.005) and coronary angiography (OR, 0.59; 95% CI, 0.37 to 0.93; p = 0.02). A significant interaction between age and gender was found (p = 0.002); therefore, women ≥ 75 years old had a much lower probability of undergoing noninvasive tests and coronary angiography than men of the same age.

Conclusion: Despite their worse prognosis, women undergo noninvasive studies and coronary angiography less frequently than men after an acute inferior or posterior MI. The gender gap increases in patients ≥ 75 years old.


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