Women with ACS had longer time to care, less CAG/PCI, higher in-hospital death (12% vs 7%, HR 1.8) and follow-up mortality (15% vs 11%, HR 1.5) than men.
Does female sex impact healthcare accessibility, management, and prognosis in patients with acute coronary syndromes compared to male sex?
Women with acute coronary syndromes experience longer delays to first medical contact, are less likely to undergo invasive angiography or PCI, and suffer significantly higher in-hospital and long-term mortality compared to men.
Absolute Event Rate: 0% vs 0%
Abstract Background Sex disparity in access to healthcare and management of cardiovascular disease (CVD) is still significant, leading to suboptimal treatment of acute coronary syndromes (ACS). This study aims to evaluate differences in accessibility, management and its prognosis between women and men with ACS. Methods Multicenter retrospective cohort of 6000 patients with ACS was divided according to patient’s sex. CV risk factors, time to first medical care (FMC), to ECG, coronary angiography (CAG) and percutaneous coronary intervention (PCI) were evaluated. The outcomes assessed were major adverse cardiac events (MACE), in hospital and follow-up death, reference to cardiac rehabilitation and hospital readmission. Results From the 6000 patients, 30% (n=1784) were female, with mean age of 73±13 years. 70% (n=4216) of the patients were male, with mean age of 65±13years. Women were significantly older (p0,001). Despite the significantly higher prevalence of CV risk factors in women, namely hypertension (81% vs 69%, p0,001), diabetes (38% vs 31%, p0,001) and dyslipidemia (60% vs 57%, p=0,02), the me to FMC is statistically significantly longer in women (10,6 hours vs 9,5 hours, p0,001), and the median me to ECG was similar (101 min vs 110 min, p=0,9). Non-ST segment elevation ACS (NSTE-ACS) was higher in women (65% vs 61% p0,001 OR 1,2 1,1-1,4). Female patients were significantly less likely to undergo CAG, (68% vs 79% p0,001 OR 0,6 0,5-0,7), and to be done less PCI than men (82% vs 86% p0,001 OR 0,7 0,6-0,8). Sll, there were no statistically significant differences in terms of unfavorable anatomy (63% vs 66%, p=0,5), and women had less multivessel disease (12% vs 18% p0,001). Successful PCI was similar among groups (95% p=0,9). About outcomes, women’s in-hospital death and MACE were higher than men’s (12% vs 7% p0,001 HR 1,8 1,5-2,2 and 7% vs 5% p=0,005, HR 1,5 1,1-2). Women had more heart failure (28% vs 19%, p0,01 HR 1,7 1,5-1,9), cardiogenic shock (8% vs 5%, p0,001 HR 1,6 1,3-2), and mechanical complications (2% vs 1% p0,01 HR 2,5 1,6-3,8). There were no differences in myocardial infarction (1% vs 1%, p=0,6). Women were less likely to be referenced to cardiac rehabilitation (33% vs 38% p0,001 OR 0,8 0,7-0,9). Mean follow-up was 16±7 months. Women had a statistically higher mortality during follow-up (15% vs 11% p0,001 HR 1,5 1,2-1,7). The median survival me was statistically inferior in women (48 months vs 54 months p0,001). Also women had significantly more hospital readmissions (28% vs 24% p=0,004 OR 1,2 1,1-1,4). The median me of hospital admission was statistically inferior in women (39 months vs 46 months p0,001). Conclusion Despite the awareness, CVD in women remains underestimated. Women take longer to seek medical care and are less likely to undergo to CAG and PCI. This ends in worse early and long-term prognosis, with higher mortality and MACE on follow-up.
Almeida et al. (Sat,) reported a other. Women with ACS had longer time to care, less CAG/PCI, higher in-hospital death (12% vs 7%, HR 1.8) and follow-up mortality (15% vs 11%, HR 1.5) than men.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: