BACKGROUND AND OBJECTIVES: Previous studies have suggested that women with AMI are less aggressively managed than men. The aim of this study was to assess the differences between the sexes, in terms of the medical and invasive coronary procedures, in AMI patients during the 1990s, and the association to in-hospital mortality. SUBJECTS AND METHODS: In 1758 AMI patients, the baseline clinical characteristics, initial management and in-hospital outcomes, were studied. RESULTS: The women, on average, were older than men (68.8+/-10.6 versus 59.2+/-12.3, p<0.01), with a higher prevalence of diabetes and hypertension. Women received heparin and b-blockers less often than men. The unadjusted rates of thrombolysis, angiography and PTCA use were lower in women than men, but not after covariate adjustment. The in-hospital mortality was higher in women than men (11.7% versus 8.1%, odd ratio (OR) 1.51, 95% CI 1.09 to 2.11, p<0.05), but this difference was not significant after adjustment for age (adjusted OR 0.98, 95% CI 0.69 to 1.40, p=NS). CONCLUSION: Women with AMI are less aggressively managed than men, and have higher in-hospital mortalities. The difference in outcome seems to be associated with increased age, with a greater co-morbidity of women.