Population-level differences in revascularization treatment and outcomes among various United States subpopulations

Table 2 Summary of disparities in acute myocardial infarction co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in women

Co-morbidities and presentation symptoms

More hypertension and diabetes than men[24]

More diabetes, dyslipidemia, obesity, angina, stroke, and congestive heart failure; worse physical function; and poorer quality of life than men[28]

More hypertension, diabetes, lung disease, depression, and angina; worse general health scores; poorer physical function; and worse quality of life than men[30]

Women ≤ 55 yr of age more likely than men to present without chest pain or with NSTEMI[35]

Women < 45 yr of age more likely than men to present without chest pain, but this reversed with age[36]

Risk less likely to be accurately assessed by standard models or assays[39,40]

More likely than men to be older and have hypertension, hyperlipidemia, and congestive heart failure and less likely to have previous history of MI or revascularization[44]

Women ≤ 55 yr of age more likely to have low income, more diabetes, more hypertension, more family history of CVD, more previous CVD events, and more depression and anxiety; less likely to have diagnosis of STEMI and more likely to have NSTEMI or unstable angina[46]

Higher baseline stress than men[67]

Care/medical resources

Lower rates of hospitalization for AMI and lower rates of PCI as treatment for AMI compared to men[42]

Longer pre-hospital delay from onset of symptoms compared to men[43]

Longer symptom-onset-to-balloon time than men and more likely to be treated with medical management only; less likely to receive b-blockers and statins on discharge[44]

Greater delays than men in both door-to-code and door-to-balloon times[45]

Less likely than men to receive ECG or fibrinolytic therapy within guideline times, to have reperfusion therapy with STEMI, or to have PCI with NSTEMI[46]

Longer door-to-thrombolytic time than men[47]

Less likely than men to have statin treatment for high cholesterol[48]

Women with in-hospital STEMI less likely to have cardiac catheterization or PCI than men[49]

Less likely than men to be using ACE inhibitors, angiotensin receptor blockers, and β-blockers 30 d after discharge[50]

Less likely than men to be told their symptoms could be related to heart disease or to have cardiovascular testing or cardiac catheterization recommended[51]

Less likely than men to be treated with either primary PCI or CABG[73]

Outcomes

Greater mortality than men at 30 d and at 1 yr in women < 65 yr, but only at 30 d in women ≥ 65 yr[24]

Greater in-hospital mortality than men for both STEMI and NSTEMI in women ≤ 69 yr[58]

Greater in-hospital mortality than men for STEMI in women < 80 yr, and greater in-hospital mortality than men for NSTEMI in women ≤ 69 yr[59]

More in-hospital mortality for AMI than men[60]

Higher 30-d mortality rates for AMI than men up to age 75 yr[61]

Higher post-AMI mortality rates than men at both 5 and 10 yr[62]

More in-hospital complications than men, including mortality, MI, bleeding, and vascular complications[63]

More likely than men to be re-hospitalized for ACS within 1 yr[64]

Worse recovery than men at 1 mo post-AMI in angina, overall quality of life, and mental health[67]

Clinically significant lower health-related quality of life scores than men at 1, 6, and 12 mo following ACS event[68]

Higher re-hospitalization rates and lower quality of life than men at 6 mo after AMI[69]

Greater risk of 1-yr re-hospitalization for AMI and higher 1-yr mortality than men[93]

AMI: Acute myocardial infarction; CVD: Cardiovascular disease; STEMI: ST-segment elevation myocardial infarction; CABG: Coronary arterybypass grafting; PCI: Percutaneous coronary intervention; ECG: Electrocardiogram; ACE: Angiotensin converting enzymes; ACS: Acute coronary syndromes.