We conducted a retrospective cohort study based on a case note review to
determine whether there are differences in the treatment pathways followed for
men and women admitted with acute myocardial ischemia and infarction after
adjusting for differences in case mix. Women were as likely as men to receive
thrombolysis, but were less likely subsequently to undergo exercise testing
(adjusted odds ratio, 0.58; 95% CI, 0.40–0.84) or angiography (adjusted
odds ratio, 0.62; 95% CI, 0.39–0.99). Coronary anatomy was the strongest
predictor of revascularization regardless of sex. Women with diagnosed cardiac
pain are less likely than men to be placed on the investigative pathways that
lead to revascularization. Those women who are investigated are as likely as
men to undergo revascularization. These findings are independent of the
effects of age, angina grade, comorbidity, or cardiac risk factors.
Clinicians' and patients' beliefs and preferences about treatment
require investigation.