Objectives: To examine determinants of use of cardiac procedures after acute myocardial infarction and identify variation factors.

Methods: Observational prospective cohort study of 2,519 patients in 48 centers with a two-level logistic-regression analysis.

Results: Elderly patients were less likely to undergo pre- and inhospital thrombolysis (odds ratios, 0.71 and 0.64; 95% CI, 0.62–0.81 and 0.58–0.69, respectively). The elderly, females, and patients with heart failure on admission were less likely to undergo noninvasive tests (0.74, 0.62, and 0.51; 95% CI, 0.67–0.81, 0.46–0.83, and 0.38–0.68, respectively) and coronary angiography (0.38, 0.53, and 0.67; 95% CI, 0.34–0.42, 0.38–0.74, and 0.52–0.86, respectively) but not revascularization. Hospital factors were more difficult to interpret.

Conclusions: Elderly, women, and heart failure patients underwent fewer cardiac procedures than lower-risk patients. Physicians should change their attitude toward these groups and use advanced procedures, bearing in mind the patients' needs rather than good procedural outcomes.