ABSTRACT
Although recent advances in the pharmacological treatment of myocardial infarction (MI) with agents such as intravenous beta-blockade, aspirin, and thrombolytic drugs have dramatically improved the short-and long-term prognosis in patients with acute MI (Dellborg, Eriksson, Riha, & Swedberg, 1994), women still have a significantly higher in-hospital mortality as compared to men (Wilkinson, Kooridhottumkal, Kulasegaram, Parsons, & Timmis, 1994). There are several explanations for the higher in-hospital mortality in women: higher age at the time of infarction, an increased prevalence of diabetes, longer delay before seeking medical attention, less distinctive symptoms of myocardial ischemia, and less coronary angiography and revascularization (Ayanian & Epstein, 1991). An additional explanation may be less aggressive pharmacological treatment in women, as re-cently shown by our group (Dellborg & Swedberg, 1993) as well as confirmed by others (Clarke, Gray, Keating, & Hampton, 1994). Several of the agents used for treating MI have potential severe side effects such as intracerebral bleeding after thrombolysis, and these treatments are therefore generally only given to patients who exhibit distinct signs on the electrocardiogram of an acute ongoing MI. Patients with at least 1-2 mm of ST-segment elevation are generally considered for thrombolytic treatment, whereas patients with similar symptoms but less electrocardiographic changes in most hospitals do not receive such treatment. The number of patients with acute chest pain presenting to any emergency department widely exceeds the capacity of the coronary-care unit. Thus, the electrocardiogram is also used for selecting patients with a moderate or high probability of infarction, whereas patients without electrocardiographic signs of ischemia will either be admitted to observation units or sent home.
