In-hospital outcomes and long-term mortality according to gender and management strategy in acute myocardial infarction. Insights from the FAST-MI 2005 registry

Background: The early mortality of acute myocardial infarction (AMI) has dramatically decreased in the recent past. Whether the previously reported gender disparities in use of invasive strategies (IS) persist and translate into differences in outcomes deserves to be examined. Methods: We used the data from a nationwide French prospective multicentre registry from 3,670 AMI patients (1155 women (31.5%), 2515 men (68.5%)) recruited in 223 centers in 2005 and followed-up for 3 years. We examined in-hospital outcomes and 3-year mortality in patients categorized according to gender and use of IS (i.e. coronary angiography during the hospitalisation with a view to revascularisation). Results: IS was less frequently used in women than in men (adjusted OR=0.66; 95% CI: 0.52-0.85), regardless of the type of AMI, age group or risk category, while use of recommended medications was similar at 48 hours and discharge. In-hospital mortality did not differ according to gender, whatever the age group and use of an IS. At 3 years, overall and post-discharge mortality were similar in men and women. However, IS was associated with lower 3-year mortality (women: HR=0.54; 95% CI: 0.41-0.70; men: HR=0.50; 95% CI: 0.39-0.63) and there was no gender-strategy interaction. Conclusion: Invasive strategy remains less frequently used in women than in men, yet is associated with improved three-year survival irrespective of gender. Whether reducing the gender gap in its use would translate into a higher survival in women remains an open question.