Surgery after heart attack less likely in women

NEW YORK (Reuters Health) - Women who have suffered a heart attack are treated less often with "revascularization" -- operations like coronary bypass or angioplasty, for example, that restore blood flow to the heart muscle -- than their male counterparts, a study shows.

Women are also less likely to be admitted to hospitals with revascularization services or to undergo revascularization even when admitted to hospitals with this capability.

However, the rates of in-hospital mortality continued to be higher among women who underwent revascularization, according to the study appearing in the American Journal of Cardiology.

Dr. Jing Fang and a colleague from Albert Einstein College of Medicine, Bronx, New York, previously observed that people in neighborhoods with no hospital capable of revascularization are less likely to undergo revascularization after an acute heart attack than are those who live in neighborhoods with hospitals capable of revascularization. In addition, women have been reported to undergo revascularization less often than men after a heart attack.

To further investigate, the two researchers used New York City hospital discharge records to evaluate revascularization rates for 93,978 patients (43.7 percent women) who were hospitalized with an acute heart attack between 1995 and 2002.

A total of 27 percent of patients were revascularized, and the rates of revascularization were 32 percent in men and 20 percent in women, a significant difference.

Forty-five percent of women were admitted to hospitals capable of revascularization, compared with 52 percent of men. Women were also less likely to undergo revascularization when admitted to hospitals that provided revascularization (54 percent versus 60 percent).

Hospital admission and revascularization rates were both significantly higher among men than among women (22 percent and 28 percent, respectively.) Furthermore, after revascularization, the rate of in-hospital death was still significantly higher among women (14.5 percent) than among men (9.6 percent).

In addition to adjusting the data for revascularization rates, the investigators also adjusted for all available socioeconomic factors. This did not eliminate the gender disparity of in-hospital mortality after acute heart attack, and men continued to have a mortality advantage.

The researchers suggest that physiologic differences between men and women may partially explain the mortality rates, and "we cannot assume that the same management strategies will apply for men and women."

SOURCE: American Journal of Cardiology June 2006.