Fibrinolytic therapy in young women with acute myocardial infarction

Study objective: Previous studies found that women with acute myocardial infarction (AMI) receive less aggressive therapy compared with men. We sought to determine the percentage of young women (≤50 years) with an AMI eligible for fibrinolytic therapy who received it and explore factors resulting in the ineligibility of women for fibrinolytic therapy. Methods: A retrospective chart review was conducted for women 50 years of age or younger who were discharged from a tertiary cardiac care hospital with a diagnosis of AMI during the period 1990 to 1995. Women were included if they met the World Health Organization criteria for AMI. Results: There were 126 women meeting inclusion criteria with 54 (43%) receiving fibrinolytic therapy. Sufficient information to determine eligibility for fibrinolytic therapy was available for 118 (94%) of the women. Forty-one (91%) of the 45 women who met eligibility criteria received fibrinolytic therapy. Of the 73 women who were ineligible for fibrinolytic therapy, 52 (71%) had a nondiagnostic ECG, 28 (38%) presented 12 hours after symptom onset, and 19 (26%) had an absolute or relative contraindication to fibrinolytic therapy. Of the women not meeting eligibility requirements, 15% nonetheless received fibrinolytic therapy. Conclusion: In this study, most young women with AMI who were eligible for fibrinolytic therapy received it. Nondiagnostic ECG and late presentation to the emergency department (>12 hours after symptom onset) were the most common reasons for ineligibility.