Gender inequality in the clinical outcomes of equally treated acute coronary syndrome patients in Saudi Arabia

Abstract

BACKGROUND AND OBJECTIVESGender associations with acute coronary syndrome (ACS), remain inconsistent. Gender-specific data in the Saudi Project for Assessment of Coronary Events registry, launched in December 2005 and currently with 17 participating hospitals, were explored.DESIGN AND SETTINGSA prospective multicenter study of patient with ACS in secondary and tertiary care centers in Saudi Arabia were included in this analysis.PATIENTS AND METHODSPatients enrolled from December 2005 until December 2007 included those presented to participating hospitals or transferred from non-registry hospitals. Summarized data were analyzed.RESULTSOf 5061 patients, 1142 (23%) were women. Women were more frequently diagnosed with non ST-segment elevation myocardial infarction (NSTEMI [43%]) than unstable angina (UA [29%]) or ST-segment elevation myocardial infarction (STEMI [29%]). More men had STEMI (42%) than NSTEMI (37%) or UA (22%). Men were younger than women (57 vs 63 years) who had more diabetes, hypertension, and hyperlipidemia. More men had a history of coronary artery disease. More women received angiotensin receptor blockers (ARB) and fewer had percutaneous coronary intervention (PCI). Gender differences in the subset of STEMI patients were similar to those in the entire cohort. However, gender differences in the subset of STEMI showed fewer women given β-blockers, and an insignificant PCI difference between genders. Thrombolysis rates between genders were similar. Overall, in-hospital mortality was significantly worse for women and, by ACS type, was significantly greater in women for STEMI and NSTEMI. However, after age adjustment there was no difference in mortality between men and women in patients with NSTEMI. The multivariate-adjusted (age, risk factors, treatments, door-to-needle time) STEMI gender mortality difference was not significant (OR=2.0, CI: 0.7–5.5; P=.14).CONCLUSIONThese data are similar to other reported data. However, differences exist, and their explanation should be pursued to provide a valuable insight into understanding ACS and improving its management.

Gender-based difference in early mortality among patients with STsegment elevation myocardial infarction: insights from Kermanshah STEMI Registry

“…22 Likewise, Birkemeyer et al reported that women were significantly older, with a higher prevalence of HTN and DM, and men were more likely to be current smokers. 23 Also, consistent with some other reports, 24,25 this study found no significant differences in treatment with primary PCI for women and men; however, DTB and STB were delayed slightly in women compared to men. These results support the findings of previous studies that women typically experienced a delay in DTB and STB.…”

“…20 Also, Hersi and colleagues' survey in Saudi Arabia showed that female gender was an independent risk factor for in-hospital mortality in STEMI. 24 Likewise, in a study conducted by Lawesson et al, female sex was independently linked to higher in-hospital mortality. 34 Differences in inclusion criteria and patients' selection, sample size, clinical and socio-demographic characteristics, and treatment strategies might unfold these different results.…”

Prevalence of Vitamin D Deficiency in Acute Coronary Syndrome in a Tertiary Care Hospital, Maharashtra, India

“…Similarly, Hersi A et al (2013) found in a study conducted in coronary syndrome patients, that males were predominant (77%). [33] In the current study, the percentage of Vitamin D deficiency individuals among the study population amounted to 46% and Vitamin D insufficiency 33%. Similarly, Luis et al (2013) confirmed high vitamin D deficiency among coronary syndrome patients (98%).…”

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“…This finding was different from reports from South Africa (Ranjith et al, 2005). Males constituted more than half of patients admitted with ACS (56%), while reports from Saudi Arabia showed male predominance of 77% (Hersi et al, 2013).…”