What is the clinical evidence from this study?

Study design: Observational. Population: Acute Coronary Syndromes (ACS) (n=1565). Intervention: Female gender vs. Male gender. Primary outcome: 30-day mortality (OR 1.40, 95% CI 0.62, 3.16).

April 24, 2013Open Access

Association between Gender, Process of Care Measures, and Outcomes in ACS in India: Results from the Detection and Management of Coronary Heart Disease (DEMAT) Registry

Key Result

Female gender was not significantly associated with differences in 30-day mortality (OR 1.40) or major adverse cardiovascular events compared to male gender in Indian patients with acute coronary syndromes.

Study Design

Type

Observational (n=1,565)

Multicenter

Yes

Structured PICO

Are there gender differences in presentation, management, and 30-day outcomes among suspected ACS patients in India?

Population

1,565 suspected ACS patients (334 women; 1,231 men) from ten tertiary care centers throughout India between 2007-2008

Intervention

Female gender

Comparator

Male gender

Outcome

30-day death and major adverse cardiovascular event (MACE; death, re-hospitalization, and cardiac arrest) ratescomposite

In a registry of suspected ACS patients in India, in-hospital management, discharge management, and 30-day outcomes did not significantly differ between men and women after adjustment.

Main Result

Effect estimate: OR 1.40 (95% CI 0.62, 3.16)

Absolute Event Rate: 3% vs 1.8%

Limitations

Modest sample size with relatively few events to compare differences in outcomes
Follow-up time of 30 days may not have been long enough to detect a true divergence in outcomes
Included patients from a limited number of urban, tertiary care centers and may not be generalizable to other centers
Observational data are susceptible to residual confounding
Did not collect data on relative or absolute contraindications for medical therapy

Abstract

BACKGROUND: Studies from high-income countries have shown that women receive less aggressive diagnostics and treatment than men in acute coronary syndromes (ACS), though their short-term mortality does not appear to differ from men. Data on gender differences in ACS presentation, management, and outcomes are sparse in India. METHODS AND RESULTS: The Detection and Management of Coronary Heart Disease (DEMAT) Registry collected data from 1,565 suspected ACS patients (334 women; 1,231 men) from ten tertiary care centers throughout India between 2007-2008. We evaluated gender differences in presentation, in-hospital and discharge management, and 30-day death and major adverse cardiovascular event (MACE; death, re-hospitalization, and cardiac arrest) rates. Women were less likely to present with STEMI than men (38% vs. 55%, p<0.001). Overall inpatient diagnostics and treatment patterns were similar between men and women after adjustment for potential confounders. Optimal discharge management with aspirin, clopidogrel, beta-blockers, and statin therapy was lower for women than men, (58% vs. 65%, p = 0.03), but these differences were attenuated after adjustment (OR = 0.86 (0.62, 1.19)). Neither the outcome of 30-day mortality (OR = 1.40 (0.62, 3.16)) nor MACE (OR = 1.00 (0.67, 1.48)) differed significantly between men and women after adjustment. CONCLUSIONS: ACS in-hospital management, discharge management, and 30-day outcomes did not significantly differ between genders in the DEMAT registry, though consistently higher treatment rates and lower event rates in men compared to women were seen. These findings underscore the importance of further investigation of gender differences in cardiovascular care in India.

Ask AI

Helpful

Bookmark

View Full Paper