Female patients with acute coronary syndrome had higher unadjusted 1-year mortality than men (17.3% vs 11.4%), which was largely explained by baseline and management differences (adjusted OR 1.09).
Observational (n=7,930)
Yes
Does female gender compared to male gender affect presentation, management, and 1-year mortality in patients with acute coronary syndrome?
Higher 1-year mortality in women with ACS compared to men is largely driven by baseline clinical differences and less frequent use of guideline-directed medical and invasive therapies.
Odds Ratio: 1.62 (95% CI 1.37–1.91)
Absolute Event Rate: 17.3% vs 11.4%
p-value: p=<0.001
BACKGROUND: Gender-related differences in mortality of acute coronary syndrome (ACS) have been reported. The extent and causes of these differences in the Middle-East are poorly understood. We studied to what extent difference in outcome, specifically 1-year mortality are attributable to demographic, baseline clinical differences at presentation, and management differences between female and male patients. METHODOLOGY/PRINCIPAL FINDINGS: Baseline characteristics, treatment patterns, and 1-year mortality of 7390 ACS patients in 65 hospitals in 6 Arabian Gulf countries were evaluated during 2008-2009, as part of the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2). Women were older (61.3±11.8 vs. 55.6±12.4; P<0.001), more overweight (BMI: 28.1±6.6 vs. 26.7±5.1; P<0.001), and more likely to have a history of hypertension, hyperlipidemia or diabetes. Fewer women than men received angiotensin-converting enzyme inhibitors (ACE), aspirin, clopidogrel, beta blockers or statins at discharge. They also underwent fewer invasive procedures including angiography (27.0% vs. 34.0%; P<0.001), percutaneous coronary intervention (PCI) (10.5% vs. 15.6%; P<0.001) and reperfusion therapy (6.9% vs. 20.2%; P<0.001) than men. Women were at higher unadjusted risk for in-hospital death (6.8% vs. 4.0%, P<0.001) and heart failure (HF) (18% vs. 11.8%, P<0.001). Both 1-month and 1-year mortality rates were higher in women than men (11% vs. 7.4% and 17.3% vs. 11.4%, respectively, P<0.001). Both baseline and management differences contributed to a worse outcome in women. Together these variables explained almost all mortality disparities. CONCLUSIONS/SIGNIFICANCE: Differences between genders in mortality appeared to be largely explained by differences in prognostic variables and management patterns. However, the origin of the latter differences need further study.
Shehab et al. (Wed,) conducted a observational in Acute Coronary Syndrome (ACS) (n=7,930). Female gender vs. Male gender was evaluated on 1-year mortality (OR 1.62, 95% CI 1.37-1.91, p=<0.001). Female patients with acute coronary syndrome had higher unadjusted 1-year mortality than men (17.3% vs 11.4%), which was largely explained by baseline and management differences (adjusted OR 1.09).