Are there sex-differences in the management and clinical outcomes among patients with acute coronary syndrome?
Despite women experiencing longer delays to ECG and PCI and lower rates of ticagrelor use, in-hospital cardiovascular mortality and ADHF did not significantly differ between sexes after covariate adjustment.
BACKGROUND: The current study was to compare the management and clinical outcome between women and men with acute coronary syndrome (ACS). METHOD: This was a retrospective study. Patients with ACS presented to the emergency department were enrolled. Management and clinical outcomes (including mortality and acute decompensated heart failure ADHF) were compared between women and men. RESULTS: A total of 686 patients were included and women accounted for 38.5% (n = 264). Women were less likely to receive ticagrelor at the emergency department (18.2% vs 25.1%). Duration from arrival at the emergency department to undergo electrocardiogram was longer in women (7.5 min vs 5.3 min). The duration from symptom onset to undergo percutaneous coronary intervention was longer in women (14.4 h vs 7.2 h). After adjusting for covariates, odds ratio (OR) for cardiovascular mortality was 0.42 (95% confidence interval CI 0.37-1.02) and ADHF was 0.63 (95% CI 0.55-1.01) for women vs men. Socioeconomic status, duration from symptom onset to arrive at the emergency department, and management at the emergency department were the important factors contributing to the sex-differences in clinical outcome. CONCLUSION: Among ACS patients undergoing PCI, there was no sex-difference in in-hospital clinical outcome after adjusting for covariates. Future studies are needed to evaluate whether improving management at the emergency department can improve clinical outcomes in women and men with ACS.
Zou et al. (Wed,) studied this question.