Sex differences in use of coronary revascularization in elderly patients after acute myocardial infarction: a tale of two therapies.

Objectives: To determine if there are sex differences in the use of coronary revascularization in elderly patients after acute myocardial infarction (AMI), and if sex differences vary by type of revascularization therapy.

Design: Retrospective analysis of medical record data.

Setting: US acute-care nongovernment hospitals.

Patients: A total of 66,830 Medicare patients > or =65 years old hospitalized with AMI.

Interventions: None.

Measurements And Results: We assessed sex differences in the use of coronary revascularization within 60 days of hospital admission among patients who had undergone cardiac catheterization. Multivariable logistic regression models were used to derive risk-standardized rates of any coronary revascularization, coronary artery bypass graft (CABG) surgery, and percutaneous coronary intervention (PCI) adjusted for patient and hospital characteristics. Women had lower crude overall rates of coronary revascularization compared with men (65.2% vs 68.7%, p < 0.001). Multivariable adjustment reduced the sex difference in the overall coronary revascularization rate from 3.5 to 2.1% (66.0% women vs 68.1% men, p = 0.001). Sex differences in coronary revascularization use, however, varied by type of revascularization therapy. Women had lower risk-standardized rates of CABG surgery compared with men (27.0% vs 32.9%, p < 0.001), but had higher risk-standardized rates of PCI (42.0% vs 38.2%, p < 0.001), particularly among patients > 85 years old (45.8% vs 38.9%, p = 0.011).

Conclusions: Among Medicare patients hospitalized with AMI, women are slightly less likely to undergo coronary revascularization after cardiac catheterization; however, sex differences in coronary revascularization vary by type of therapy.