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CLINICAL STUDIES

Utilization of coronary angiography and revascularization after acute myocardial infarction in men and women risk stratified by the American College of Cardiology/American Heart Association guidelines

Prasad K. Kilaru, MD^*, Russell F. Kelly, MD, FACC^* , James E. Calvin, MD, FACC^* and Joseph E. Parrillo, MD, FACC

^* Division of Cardiology, Cook County Hospital, Chicago, Illinois, USA
Section of Cardiology, Rush–Presbyterian–St. Luke’s Medical Center, Chicago, Illinois, USA

Manuscript received April 30, 1999; revised manuscript received October 25, 1999, accepted December 2, 1999.

Reprint requests and correspondence: Dr. Russell F. Kelly, 1725 W. Harrison Street, Suite 1159, Chicago, Illinois 60612
rkelly{at}rush.edu

OBJECTIVES

We sought to determine whether men and women are equally likely to receive coronary angiography and revascularization after acute myocardial infarction (AMI) when they are risk stratified according to American College of Cardiology/American Heart Association (ACC/AHA) practice guidelines for post-MI care.

BACKGROUND

Several previous studies have suggested that women may undergo angiography and revascularization procedures less frequently than men.

METHODS

In 439 consecutive patients admitted to a public hospital with AMI, rates of coronary angiography and revascularization were compared in men and women categorized, according to ACC/AHA practice guidelines, as having strong (class I or IIa) or weaker (class IIb) indications for angiography.

RESULTS

Women were older and more likely to be diabetic or hypertensive, but men and women were equally likely to meet class I/IIa criteria for post-MI angiography (both 51%). Angiography rates were nearly identical in men and women overall (63% vs. 64%), as well as in patients in class I/IIa (80% vs. 82%) and class IIb (46% vs. 46%) (all p > 0.80, with >80% power to detect important differences); the only multivariate predictors of post-MI angiography were age and ACC/AHA class. Significant coronary artery disease was equally prevalent in men and women undergoing angiography, and men and women were equally likely to undergo revascularization, whether they were in class I/IIa (both 55%, p = 0.90) or class IIb (59% vs. 58%, p = 0.88). No significant differences in mortality were noted between men and women.

CONCLUSIONS

Despite being older and having more risk factors than men, women were equally likely to undergo coronary angiography and revascularization procedures after AMI, and they had in-hospital clinical outcomes that were at least as favorable.

Abbreviations and Acronyms   ACC/AHA = American College of Cardiology/American Heart Association   AMI = acute myocardial infarction   CAD = coronary artery disease

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