Sex disparities in procedure use for acute
myocardial infarction in the United States,
1995 to 2001
Alain G. Bertoni, MD, MPH,
Denise E. Bonds, MD, MPH,
James Lovato, MS,
David C. Goff, MD, PhD,
Frederick L. Brancati, MD, MHS
Winston-Salem, NC, and Baltimore, Md
Sex disparities in procedure use for acute myocardial infarction (AMI) have been well documented in
selected populations in the 1980s and early 1990s. As little is known about more recent trends in sex disparities in the
general population, we analyzed more recent rates of catheterization, angioplasty, and coronary artery bypass grafting
(CABG) performed before discharge for acute myocardial infarction.
Data from representative civilian hospitals in 33 US states in the Nationwide Inpatient Sample from 1995
to 2001 were used to identify men and women discharged with a primary diagnosis of acute myocardial infarction. Re-
ceipt of cardiac catheterization, angioplasty, stent placement, or CABG was determined. Multivariate Poisson modeling
was used to determine the likelihood of procedure receipt by sex, adjusting for demographic, comorbidity, and hospital
From 1995 to 2001, the adjusted proportion receiving catheterization, angioplasty, and stents increased in
women as well as men, whereas the adjusted proportion receiving CABG declined slightly. Women were nearly as likely
as men to undergo catheterization (adjusted prevalence ratio [PR], 0.96; 95% CI, 0.95 to 0.97), angioplasty (adjusted
PR, 0.98; 95% CI, 0.97 to 0.99), or stent placement (adjusted PR, 0.96; 95% CI, 0.95 to 0.97). Women remained less
likely to undergo CABG (adjusted PR, 0.78; 95% CI, 0.77 to 0.79).
These recent nationwide data suggest that compared with men, women are nearly as likely to
undergo catheterization-based procedures but remain less likely to undergo CABG. (Am Heart J 2004;147:
There have been numerous studies on sex differ-
ences in procedure use in the late 1980s and early
1990s for ischemic heart disease, especially acute myo-
cardial infarction (AMI). Most
but not all
found that women are less likely to have diagnostic or
interventional procedures. Most studies used data from
focused solely on Medicare bene-
or reported on populations from lim-
ited geographic areas
and thus may not re-
ﬂect the general US population of adults with AMI.
One study from the 1980s that did use nationally rep-
resentative data on AMI and procedure use found
lower rates of catheterization, angioplasty, and by-
pass surgery in women versus men,
ization rates have increased since the 1980s.
one New England community, increasing catheteriza-
tion rates from 1990 to 1999 has led to a diminished
sex disparity in catheterization and angioplasty but
not in bypass surgery.
How the rising use of cathe-
terization and greater awareness of underutilization
of cardiac procedures in women has affected the
sex disparity nationally is uncertain. To answer this
question, we conducted a series of analyses on na-
tionally representative hospital discharge data for
the period from 1995 through 2001 to compare re-
cent rates of catheterization, angioplasty, stent
placement, and coronary artery bypass grafting
(CABG) performed before discharge for acute myo-
cardial infarction in men versus women.
From the Departments of
Department of Public Health Sciences and
cine, Wake Forest University School of Medicine, Winston-Salem, NC, and the
partments of Internal Medicine and Epidemiology, Johns Hopkins Medical Institutions,
Dr Bertoni was supported by a National Heart, Lung, and Blood Institute Training
Grant in Cardiovascular Epidemiology (5-T32 HL07180-24). Dr Brancati was sup-
ported by an Established Investigator grant from the American Heart Association (Dal-
las, Tex). Data utilized is from the “Healthcare Cost and Utilization Project (HCUP),” a
product of the Agency for Healthcare Research and Quality.
Submitted July 15, 2003; accepted November 21, 2003.
Reprint requests: Alain Bertoni, MD, MPH, Wake Forest University Baptist Medical
Center/Public Health Sciences, Medical Center Boulevard, Winston-Salem NC,
0002-8703/$ - see front matter
© 2004, Elsevier Inc. All rights reserved.