Key result
Women hospitalized with a first acute coronary syndrome were significantly less likely than men to undergo diagnostic coronary angiography within 60 days (67% vs 80%; HR 0.86; 95% CI 0.84-0.89).
Why the study?
Does female sex reduce the likelihood of undergoing invasive diagnostic and therapeutic procedures in patients with acute coronary syndromes?
Cohort (n=52,565)
Yes
Does female sex reduce the likelihood of undergoing invasive diagnostic and therapeutic procedures in patients with acute coronary syndromes?
Women hospitalized with a first ACS are significantly less likely to undergo invasive diagnostic and therapeutic procedures compared to men, a disparity that persisted from 2005 to 2011.
Women with ACS remain less likely to receive invasive care; leaves open mechanisms and need for prospective studies.
OBJECTIVES: To investigate for trends in sex-related differences in the invasive diagnostic-therapeutic cascade in a population of patients with acute coronary syndromes (ACS). DESIGN: A nationwide cohort study. SETTING: Administrative and clinical registries covering all hospitalisations, invasive cardiac procedures and deaths in the Danish population of 5.6 million inhabitants. PARTICIPANTS: We included 52,565 patients aged 30-90 years who were hospitalised with a first ACS from January 2005 to November 2011. Follow-up was 60 days from the day of index admission. MAIN OUTCOME MEASURES: Diagnostic coronary angiography, percutaneous coronary intervention or coronary artery bypass within 60 days of index admission. RESULTS: Women constituted 36%, were older, had more comorbidity and were less likely to be admitted to a hospital with cardiac catheterisation facilities than men. Mortality rates were similar for both sexes. Diagnostic coronary angiography was performed less frequently on women compared with men, both within 1 day (31% vs 42%; p<0.001) and within 60 days (67% vs 80%; p<0.001), yielding adjusted female-male HRs of 0.83 (0.79-0.87) and 0.86 (0.84-0.89), respectively.Among the 39,677 patients undergoing coronary angiography, non-obstructive coronary artery disease was more frequent among women than men (22% vs 9%; p<0.001). Women were less likely to undergo percutaneous coronary intervention (58% vs 72%; p<0.001) and coronary artery bypass (6% vs 11%, p<0.001) within 60 days than men, yielding adjusted HRs of 0.96 (0.92-0.99) and 0.81 (0.74-0.89), respectively. The sex-related differences were not attenuated over time for any of the invasive cardiac procedures (p values for trend >0.05). CONCLUSIONS: In this nationwide study, men were more likely to undergo an invasive approach than women when hospitalised with a first ACS--a difference persisting from 2005 to 2011. Future studies should focus on the potential mechanisms behind this differential treatment.
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Hansen et al. (2015) conducted a cohort in Acute coronary syndromes (n=52,565). Female sex vs. Male sex was evaluated on Diagnostic coronary angiography within 60 days of index admission (HR 0.86, 95% CI 0.84-0.89, p=<0.001). Women hospitalized with a first acute coronary syndrome were significantly less likely than men to undergo diagnostic coronary angiography within 60 days (67% vs 80%; HR 0.86; 95% CI 0.84-0.89).
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