Women with acute coronary syndrome experienced more treatment delays compared to men in RCTs (OR 1.43; 95% CI 1.12-1.82) and were less likely to be treated invasively.
Meta-Analysis
Are there gender differences in treatment delays, invasive management, and mortality among patients with acute coronary syndrome?
Women with ACS experience more treatment delays, are less likely to receive invasive management, and have higher crude short- and long-term mortality compared to men, though mortality differences attenuate after adjusting for covariates.
Effect estimate: OR 1.43 (95% CI 1.12-1.82)
BACKGROUND: We aimed to provide a comprehensive overview of existing gender differences in acute coronary syndrome (ACS), with respect to treatment delays, invasive management of ACS, and short and long-term mortality in patients with ACS. METHODS: We defined 37 observational studies (OSs) and 21 randomized trials (RCTs) that best corresponded to our interests. OSs and RCTs were analyzed separately. RESULTS: Women with ACS more often experienced delays in treatment compared to men (OR 1.43; 95% CI, 1.12-1.82) in RCTs. Female patients were less often treated invasively: RCTs (OR 0.87; 95% CI, 0.83-0.9), OSs: (OR 0.66; 95% CI, 0.63-0.68). Women had higher crude in-hospital mortality (OR 1.56; 95% CI, 1.53-1.59) and 30-day mortality (OR 1.71; 95% CI, 1.22-2.4) in OSs and (OR 2.74; 95% CI, 2.48-3.02) in RCTs. After adjustment for multiple covariates, gender difference was attenuated: in-hospital mortality (OR 1.19; 95% CI, 1.17-1.2), 30-day mortality (OR 1.18; 95% CI, 1.12-1.24) in OSs. Unadjusted long-term mortality in women was higher than in men (OR 1.41; 95% CI, 1.31-1.52) in RCTs and (OR 1.4; 95% CI, 1.3-1.5) in OSs. CONCLUSION: Women with ACS experience a delay in time to treatment more often than men. They are also less likely to be treated invasively. Females have shown worse crude short-and long-term all-cause mortality compared to males. However, after adjustment for multiple covariates, a less significant gender difference has been observed. Considering the difference between crude and adjusted mortality, we deem it reasonable to conduct further investigations on gender-related influence of particular risk factors on the outcomes of ACS.
Lunova et al. (Mon,) conducted a meta-analysis in Acute coronary syndrome. Female gender vs. Male gender was evaluated on Treatment delays in RCTs (OR 1.43, 95% CI 1.12-1.82). Women with acute coronary syndrome experienced more treatment delays compared to men in RCTs (OR 1.43; 95% CI 1.12-1.82) and were less likely to be treated invasively.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: