Background:
We aimed to provide a comprehensive overview of existing gender differences in acute coronary syndrome (ACS): treatment delays, invasive management of ACS, and short and long-term mortality in patients with ACS.
Methods:
We defined 37 observational studies (OSs) and 21 randomized trials (RCTs) that best corresponded to our interests. OSs and RCTs were analyzed separately.
Results:
Women with ACS more often experienced delays in treatment compared with men (OR 1.43; 95% CI, 1.12-1.82) in RCTs. Female patients were less often treated invasively: RCTs (OR 0.87; 95% CI, 0.83-0.9), OSs: (OR 0.66; 95% CI, 0.63-0.68). Women had higher crude in-hospital mortality (OR 1.56; 95% CI, 1.53-1.59) and 30-day mortality (OR 1.71; 95% CI, 1.22-2.4) in OSs and (OR 2.74; 95% CI, 2.48-3.02) in RCTs. After adjustment for multiple covariates, gender difference was attenuated: in-hospital mortality (OR 1.19; 95% CI, 1.17-1.2), 30-day mortality (OR 1.18; 95% CI, 1.12-1.24) in OSs. Unadjusted long-term mortality in women was higher than in men (OR 1.41; 95% CI, 1.31-1.52) in RCTs and (OR 1.4; 95% CI, 1.3-1.5) in OSs.
Conclusion:
Women with ACS experience delay in time to treatment more often than men. They are also less likely to be treated invasively. Females showed worse crude short-and long-term all-cause mortality compared with males. However, after adjustment for multiple covariates, a less significant gender difference was observed. Considering the difference between crude and adjusted mortality, we deem it reasonable to conduct further investigations into gender-related influence of particular risk factors on the outcomes of ACS.