What is the clinical evidence from this study?

Study design: Observational. Population: Acute coronary syndrome (n=35232). Intervention: Female sex vs. Male sex. Primary outcome: 1-year mortality in the STEMI cohort (adjusted OR 1.31, 95% CI 1.09-1.57, p=<0.003).

February 8, 2021Open Access

Sex and gender differences in presentation, treatment and outcomes in acute coronary syndrome, a 10 year study from a multi-ethnic Asian population: The Malaysian National Cardiovascular Disease Database—Acute Coronary Syndrome (NCVD-ACS) registry

Q: What are the key findings of this study?

Women with STEMI had significantly higher 1-year mortality compared to men (adjusted OR 1.31; 95% CI 1.09-1.57; p<0.003), alongside longer system delays and less aggressive treatments.

Key Result

Women with STEMI had significantly higher 1-year mortality compared to men (adjusted OR 1.31; 95% CI 1.09-1.57; p<0.003), alongside longer system delays and less aggressive treatments.

Study Design

Type

Observational (n=35,232)

Multicenter

Yes

Structured PICO

Do women with acute coronary syndrome experience different treatment patterns and clinical outcomes compared to men in a multi-ethnic Asian population?

Population

35,232 acute coronary syndrome (ACS) patients (79.44% men, 20.56% women) from 24 hospitals in Malaysia between Jan 2012 and Dec 2016, compared to a historical cohort of 13,591 ACS patients (75.8% men, 24.2% women) from Mar 2006 to Feb 2010.

Intervention

Female sex/gender

Comparator

Male sex/gender

Outcome

In-hospital, 30-day, and 1-year mortalityhard clinical

Women presenting with acute coronary syndrome in Malaysia continue to experience longer system delays, receive less aggressive medical and invasive therapies, and have significantly higher 1-year mortality in STEMI compared to men.

Main Result

Effect estimate: adjusted OR 1.31 (95% CI 1.09-1.57)

p-value: p=<0.003

Abstract

BACKGROUND: Sex and gender differences in acute coronary syndrome (ACS) have been well studied in the western population. However, limited studies have examined the trends of these differences in a multi-ethnic Asian population. OBJECTIVES: To study the trends in sex and gender differences in ACS using the Malaysian NCVD-ACS Registry. METHODS: Data from 24 hospitals involving 35,232 ACS patients (79.44% men and 20.56% women) from 1st. Jan 2012 to 31st. Dec 2016 were analysed. Data were collected on demographic characteristics, coronary risk factors, anthropometrics, treatments and outcomes. Analyses were done for ACS as a whole and separately for ST-segment elevation myocardial infarction (STEMI), Non-STEMI and unstable angina. These were then compared to published data from March 2006 to February 2010 which included 13,591 ACS patients (75.8% men and 24.2% women). RESULTS: Women were older and more likely to have diabetes mellitus, hypertension, dyslipidemia, previous heart failure and renal failure than men. Women remained less likely to receive aspirin, beta-blocker, angiotensin-converting enzyme inhibitor (ACE-I) and statin. Women were less likely to undergo angiography and percutaneous coronary intervention (PCI) despite an overall increase. In the STEMI cohort, despite a marked increase in presentation with Killip class IV, women were less likely to received primary PCI or fibrinolysis and had longer median door-to-needle and door-to-balloon time compared to men, although these had improved. Women had higher unadjusted in-hospital, 30-Day and 1-year mortality rates compared to men for the STEMI and NSTEMI cohorts. After multivariate adjustments, 1-year mortality remained significantly higher for women with STEMI (adjusted OR: 1.31 (1.09-1.57), p<0.003) but were no longer significant for NSTEMI cohort. CONCLUSION: Women continued to have longer system delays, receive less aggressive pharmacotherapies and invasive treatments with poorer outcome. There is an urgent need for increased effort from all stakeholders if we are to narrow this gap.