Objective: To compare characteristics, management, and outcome of myocardial infarction(MI) in men and women. Design: Prospective observational study. Setting: District general hospital in southwest Scotland. Participants: 966 men and 597 women admitted with first MI between 1994 and 2000 with follow up to the end of 2001. Results: 393(40.7%) men and 305(51.1%)women died during a median follow up of 3.4 years for the survivors. Univariate analysis indicated an excess mortality among women(hazard ratio(HR) 1.45, 95%confidence interval(CI) 1.25 to 1.68), which disappeared after adjustment for age, smoking, comorbidity, previous vascular disease, diabetes, hypertension, and social deprivation(HR 1.02, 95%CI 0.87 to 1.20). There was also an excess early mortality within 30 days among women(HR 1.54, 95%CI 1.20 to 1.98), though this did not retain significance after adjustment for the same covariates(HR 1.04, 95%CI 0.79 to 1.37). Small and insignificant differences were found in the proportion of men and women receiving thrombolysis on admission and secondary prophylactic drugs at discharge, except for statins and βblockers, which were respectively more(adjusted odds ratio 1.48, 95%CI 1.10 to 1.98) and less(adjusted odds ratio 0.78, 95%CI 0.60 to 1.00) commonly prescribed to women. Conclusion: Results suggest that the poorer outcome for women after MI reported in other studies may reflect sex bias in management as well as differences in age and co-morbidity and support the view that if women have access to the same quality of care as men then survival will be the same.