Age-related Differences in the Delivery of Cardiac Management to Women Versus Men With Acute Myocardial Infarction in Japan Tokai Acute Myocardial Infarction Study: TAMIS

Abstract

SUMMARYIt is of concern that women are more likely to undergo fewer diagnostic tests and receive less treatment for acute myocardial infarction (AMI) than men. However, it is still unclear whether gender differences exist according to age groups. Therefore, we studied the influence of gender on the delivery of cardiac management according to two age groups (< 65, 65) in Japan. Data from the Tokai Acute Myocardial Infarction Study (TAMIS) sample were used. This is a retrospective study of all consecutive patients admitted to the 13 acute care hospitals in the Tokai region of Japan, which includes Aichi and Shizuoka Prefectures, with a diagnosis of AMI from 1995 to 1997. A total of 143 younger women, 822 younger men, 391 older women, and 611 older men were included. Information concerning patient demographics, in-hospital course, comorbid conditions, electrocardiography (ECG), ultrasound-echocardiography (UCG), treadmill test (TMT), coronary angiography (CAG), percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG), intra-aortic balloon pump (IABP), mechanical ventilation, and in-hospital or discharge medication (thrombolytics, vasopressors, aspirin, β-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium antagonists, nitrates) were collected. Among the young, after controlling for these baseline variables, women were significantly less likely to undergo PTCA compared to men (OR, 0.54, 95%CI,. After controlling for these baseline variables, only lipid-lowering therapy tended to be more frequent in women than in men among the elderly (OR, 2.79, 95%CI, 1.47-2.58). The findings suggest that younger women with AMI are less likely than younger men to undergo PTCA, and that older women with AMI are more likely to receive lipid-lowering therapy. (Int Heart J 2005; 46: 939-948)

Effect of Emergency Percutaneous Coronary Intervention on In-Hospital Mortality of Very Elderly (80+ Years of Age) Patients With Acute Myocardial Infarction

“…These results were consistent with previous studies suggesting that older age, 1,[6][7][8] female gender, [9][10][11][12] and dementia 13) are factors inversely related to the use of invasive procedures including PCI. Increased ADL impairment in the patients without emergency PCI may have been due to the greater age of this subgroup.…”

Age Differences in the Delivery of Cardiac Management to Women Versus Men With Acute Myocardial Infarction An Evaluation of the TAMIS-II Data

“…Consistent with TAMIS, 13) the TAMIS-II data did not suggest that being female contributed to UCG or TMT use. The underuse of TMT among women may not be problematic in Japan.…”

“…Thus, the effect of gender on the in-hospital management of patients with AMI remains controversial. 1,[4][5][6][7][8][9][10][11][12] In addition, our previous retrospective study, TAMIS,13) demonstrated that the gender differences in AMI management are different between younger and older populations, which is consistent with the findings of another study.…”

“…All of the skilled nurses were also abstractors in TAMIS. The questionnaire, which had the same format as that used in TAMIS, 13) contained information on patient demographics, the in-hospital course (length of stay, ICU/CCU transfer), comorbid conditions, clinical presentation [body mass index, body temperature, systolic arterial pressure, heart rate, chest pain, pulmonary edema, shock, bleeding, ultrasound-echocardiogram (UCG), ejection fraction, treadmill test (TMT), MI location, and earlier admission activity of daily living (ADL)], and procedural characteristics [CAG, PCI, CABG, intra-aortic balloon pump (IABP), mechanical ventilation, time from onset to angiography, and in-hospital and discharge medication (thrombolytics, vasopressors, aspirin, β-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium antagonists, nitrates)]. A history of various comorbid conditions was recorded as present if it was documented in the medical charts.…”

Japanese Patients With Acute Myocardial Infarction Who Present Without Chest Pain A High-risk Group

“…Fifteen hospitals then approved the study. Thirteen out of the 15 hospitals that participated in TAMIS, 7) which was a retrospective version of TAMIS-II, were included in TAMIS-II. All 15 hospitals that participated in TAMIS-II were nonprofit general hospitals that were capable of performing coronary angiography (CAG) and percutaneous coronary intervention (PCI).…”