Women and myocardial infarction: agism rather than sexism?

OBJECTIVE: To determine whether women with myocardial infarction are treated differently from men of the same age and to assess the effect of changes in the coronary care unit admission policy. DESIGN: Clinical audit. SETTING: The coronary care unit and general medical wards of a teaching hospital. In 1990 the age limit for admission to coronary care was 65 years. This age limit was removed in 1991. PATIENTS: 539 female and 977 male patients admitted with myocardial infarction between 1990 and 1992. MAIN OUTCOMES: Admission to the coronary care unit, administration of thrombolysis, and in-hospital mortality. RESULTS: 409 men and 254 women were admitted with myocardial infarction in 1990 and 568 men and 285 women in 1992. Removal of the age limit for admission to the coronary care unit resulted in an increase in the numbers of both sexes admitted with myocardial infarction. In both years, however, proportionately more men with infarction were admitted to coronary care: 226 men (55%) and 96 women (38%) (P < 0.01) (95% CI 7 to 28) in 1990 and 459 men (81%) and 200 women (70%) (P < 0.01) (%CI 2 to 19) in 1992. Some 246 men (60%) and 133 women (52%) with infarction (P < 0.01) received thrombolytic treatment in 1990 compared with 319 men (56%) and 130 women (46%) (P < 0.01) in 1992. The mean age of women sustaining a myocardial infarction was significantly greater in both years studied. In 1992 a total of 78 men (7%) and 34 women (4%) (P < 0.05) admitted with chest pain underwent cardiac catheterisation before discharge from hospital. CONCLUSIONS: Differences in admission rates to the coronary care unit and the rate of thrombolysis between the sexes can be explained by the older age of women sustaining infarction. The application of age limits for admission to coronary care or administration of thrombolysis places elderly patients at a disadvantage. As women sustain myocardial infarctions at an older age they are placed at a greater disadvantage.