Gender Difference in the Application of Reperfusion Therapy in Patients with Acute Myocardial Infarction

Abstract

the current treatment provided in real-life situations at 1 single center and whether these reports consequently led to better outcomes. They examined the use of invasive evaluation, revascularization rates and both shortand long-term outcomes. Although the age-adjusted mortality rate was similar in women and men, there were still significant disparities in treatment. Women with nonST-segment elevation myocardial infarction (NSTEMI) were less likely to undergo invasive evaluation and PCI than their male counterparts. There has been much debate on whether women with acute coronary syndrome (ACS) should be treated the same as men. In ACS, there is no evidence of gender differences regarding the benefit of primary PCI for patients with ST-segment elevation myocardial infarction (STEMI). Halvorsen et al. [8] show that the gender gap, in terms of the likelihood of STEMI patients receiving invasive procedures (coronary angiography and PCI), if adjusted for age, does not exist anymore. However, gender differences in invasive evaluation and treatment were still observed for NSTEMI patients in their Norwegian patient cohort. Several trials of unstable angina and NSTEMI indicate that women do not benefit from a routine, early invasive treatment strategy as much as men [9–12] . In the Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators (OASIS-5) trial, women with NSTEMI did not benefit from a routine inGender difference in the application of reperfusion therapy in patients with acute myocardial infarction (AMI) has been an ongoing topic for more than 20 years [1] . Reports have repeatedly shown that women with AMI were less likely to undergo reperfusion treatment than men, and this persists to the current era [2–5] . In early trials, percutaneous coronary intervention (PCI) was also associated with more procedure-related complications and higher mortality in women than in men [6, 7] . Cardiologists worldwide have since been working on closing the gender gap in care. In 2005, the European Society of Cardiology launched the Women At Heart initiative to raise awareness and improve the quality of care for women with cardiovascular disease, and that year, women and cardiovascular disease were hot topics at the European Society of Cardiology and American Heart Association congresses. Numerous sessions and articles have been fuelling this gender difference debate, and in January 2006, Circulation devoted an entire section to highlighting women’s heart disease. The gender gap has meanwhile narrowed, and in more recent studies, reported differences between the genders were less pronounced. However, gender differences are still existent as illustrated in the article from Halvorsen et al. [8] from the University Hospital in Oslo. The authors evaluated whether recent reports on the improved outcome for women undergoing PCI affects Received: April 29, 2009 Accepted: April 30, 2009 Published online: June 25, 2009