Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002

N Engl J Med. 2005 Aug 18;353(7):671-82. doi: 10.1056/NEJMsa032214.


Background: Although increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these differences have narrowed over time.

Methods: With the use of data from the National Registry of Myocardial Infarction, we examined sex and racial differences in the treatment of patients who were deemed to be "ideal candidates" for particular treatments and in deaths among 598,911 patients hospitalized with myocardial infarction between 1994 and 2002.

Results: In the unadjusted analysis, sex and racial differences were observed for rates of reperfusion therapy (for white men, white women, black men, and black women: 86.5, 83.3, 80.4, and 77.8 percent, respectively; P<0.001), use of aspirin (84.4, 78.7, 83.7, and 78.4 percent, respectively; P<0.001), use of beta-blockers (66.6, 62.9, 67.8, and 64.5 percent; P<0.001), and coronary angiography (69.1, 55.9, 64.0, and 55.0 percent; P<0.001). After multivariable adjustment, racial and sex differences persisted for rates of reperfusion therapy (risk ratio for white women, black men, and black women: 0.97, 0.91, and 0.89, respectively, as compared with white men) and coronary angiography (relative risk, 0.91, 0.82, and 0.76) but were attenuated for the use of aspirin (risk ratio, 0.97, 0.98, and 0.94) and beta-blockers (risk ratio, 0.98, 1.00, and 0.96); all risks were unchanged over time. Adjusted in-hospital mortality was similar among white women (risk ratio, 1.05; 95 percent confidence interval, 1.03 to 1.07) and black men (risk ratio, 0.95; 95 percent confidence interval, 0.89 to 1.00), as compared with white men, but was higher among black women (risk ratio, 1.11; 95 percent confidence interval, 1.06 to 1.16) and was unchanged over time.

Conclusions: Rates of reperfusion therapy, coronary angiography, and in-hospital death after myocardial infarction, but not the use of aspirin and beta-blockers, vary according to race and sex, with no evidence that the differences have narrowed in recent years.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Aged
  • Aspirin / therapeutic use
  • Blacks*
  • Coronary Angiography / statistics & numerical data
  • Female
  • Health Services Accessibility
  • Hospital Mortality
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardial Infarction / ethnology*
  • Myocardial Infarction / therapy*
  • Myocardial Revascularization / statistics & numerical data*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Process Assessment, Health Care*
  • Quality of Health Care
  • Risk Factors
  • Sex Factors
  • United States
  • Whites*


  • Adrenergic beta-Antagonists
  • Platelet Aggregation Inhibitors
  • Aspirin