What does this research mean for the field?

Women with acute coronary syndrome in Yemen experience significant disparities in treatment, including lower rates of coronary angiography and percutaneous coronary intervention, and suffer worse in-hospital mortality compared to men. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 3, 2025Open Access

Sex-related differences in acute coronary syndrome: insights from an observational study in a Yemeni cohort

Structured PICO

Does female sex impact clinical presentation, management, and outcomes in Yemeni patients with acute coronary syndrome?

Population

1,743 patients (1,379 men and 364 women) hospitalized with acute coronary syndrome (ACS) at six tertiary care centers in Yemen between January 2020 and December 2023.

Intervention

Female sex (observational exposure)

Comparator

Male sex

Outcome

In-hospital mortality rate and one-year mortality ratehard clinical

Yemeni women with ACS experience disparities in treatment and worse in-hospital outcomes, particularly in STEMI cases, highlighting the need to address gender biases in care.

Abstract

Background Acute coronary syndrome (ACS) presents with significant sex-related differences globally, yet research within Yemen remains limited. This study investigates these differences in the clinical presentation, management, and outcomes of Yemeni patients with ACS. Methods A retrospective cohort study was conducted at six tertiary care centers, including 1,743 patients (1,379 men and 364 women) hospitalized with ACS between January 2020 and December 2023. Results On average, women were generally older than men (59.4 ± 11.7 vs. 57.9 ± 12.7 years, P = 0.031) and more frequently diagnosed with non-ST elevation ACS (35.2% vs. 28.9%, P = 0.021). Women also exhibited higher rates of traditional cardiovascular risk factors, including diabetes mellitus (31.9% vs. 20.8%, P 0.001) and hypertension (44.5% vs. 32.0%, P 0.001), but had a lower prevalence of atrial fibrillation (0.8% vs. 2.5%, P = 0.033) and less likely to engage in ACS lifestyle risk behaviors like smoking (31.0% vs. 83.0%, P 0.001) and khat chewing (53.3% vs. 83.7%, P 0.001). Women were less likely to receive coronary angiography (47.5% vs. 61.3%, P 0.001) or percutaneous coronary intervention (33.8% vs. 46.6%, P 0.001) and were discharged with fewer guideline-recommended therapies for secondary prevention. Women experienced worse in-hospital outcomes, with a significantly higher in-hospital mortality rate (12.6% vs. 7.6%, P = 0.002), especially among those with ST-elevation myocardial infarction (STEMI), which remained significant even after adjustment for all clinical confounding factors (adjusted odds ratio, 1.80; 95% CI, 1.16–2.78, P = 0.008). However, the one-year mortality rate showed no significant difference between genders. Conclusion Yemeni women with ACS experience disparities in treatment and worse in-hospital outcomes, especially in STEMI cases. Addressing gender biases through public health education, healthcare provider training, and infrastructure improvements is essential to improving outcomes.

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