Gender Disparities in the Presentation, Management and Outcomes of Acute Coronary Syndrome Patients: Data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2)

Abstract

BackgroundGender-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 FindingsBaseline 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/SignificanceDifferences 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.

Sex Differences in the Treatment and Outcome of Patients with Acute Coronary Syndrome After Percutaneous Coronary Intervention: A Population-Based Study

“…[3][4][5][6][7] Previous studies have revealed that female patients were associated with underutilization of drugs such as aspirin, betablockers, ACEIs, statins, or clopidogrel for ACS patients as compared with male patients. [8][9][10][11][12] Several studies have demonstrated that the gender differences in drug therapy in ACS patients may be related to patient demographic variables such as age, comorbidities such as heart failure, diabetes, and physician's perception of risk. [13][14][15][16] Sex differences in the treatment of ACS patients have been reported and indicate that women are less likely than men to receive interventional therapies such as percutaneous coronary intervention (PCI) with/without a stent and coronary artery bypass graft (CABG).…”

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

“…72 Another study found lower use of antithrombotics for women vs men: clopidogrel, antiplatelet glycoprotein IIb/IIIa inhibitors.…”

“…71 In 6 Middle East countries: significantly fewer women than men with ACS received ACE inhibitors, aspirin, clopidogrel, β-blockers or statins at discharge. 72 Another study found lower use of antithrombotics for women vs men: clopidogrel, antiplatelet glycoprotein IIb/IIIa inhibitors. 73 In China, only 8.9% of women received all 6 recommended medications.…”

“…Of these, 74% received PCI rather than CABG. 15,74,75,78 CABG not likely provided without angiographic evidence 71,72 and significantly fewer women with CAD receive coronary angiography. 79,80 Women with CAD have fewer PCI procedures than men.…”

“…79,80 Women with CAD have fewer PCI procedures than men. 72,73,79 Women are less likely to be given reperfusion for STEMI. 41,73,79 Women with non-STEMI or unstable angina are less likely to undergo PCI compared to men.…”