Treatment of ST-Elevation myocardial infarction in California: Evidence of a decade-long gender bias

Background: Gender disparities in the treatment of ST-Elevation Myocardial Infarction (STEMI) have been documented. Whether these differences have changed over time is less well known. This study examines 10 years of California Patient Discharge Data (CPDD) to determine the impact of gender on treatment for STEMI.

Methods: Patients with a primary diagnosis of STEMI were selected from the CPDD (1997–2006). For each patient, it was determined whether s/he received one of the following procedures: cardiac catheterization (CC), percutaneous transluminal coronary angioplasty (PTCA), cardiac stent (ST), and/or the administration of thrombolytic agents (TA). Co-morbidities were assessed and treatment differences were observed by gender. Difference of proportions tests were performed.

Results: Over 10 years, there were 261,240 discharges (75,330 women; 185,910 men) with STEMI as the primary diagnosis. Between 1997 and 2006, cardiac interventions increased for men and women; however, men were more likely than women to receive treatment for STEMI (p<0.01). For CC, 40.2% (1997) and 61.6% (2006) of women were treated, compared with 49.5% (1997) and 72.0% (2006) of men; PTCA: women 22.4% (1997) to 45.8% (2006), men 28.9% (1997) to 59.0% (2006); ST: women 11.9% (1997) to 42.2% (2006), men 15.9% (1997) to 55.4% (2006); TA: women 0.4% (1997) to 7.5% (2006), men 0.6% (1997) to 9.8% (2006).

Conclusions: While the proportion of women and men undergoing interventions following STEMI increased for both genders over 10 years, the number of women receiving these interventions remains significantly lower. Differences in care demonstrate a need for interventions addressing gender disparities.