Mortality Trends in Women and Men Presenting with Acute Coronary Syndrome: Insights from a 20-Year Registry

Abstract

BackgroundCoronary artery disease (CAD) is the leading cause of mortality worldwide. The present study evaluated the impact of gender in patients hospitalized with acute coronary syndromes (ACS) over a 20-year period in Qatar.MethodsData were collected retrospectively from the registry of the department of cardiology for all patients admitted with ACS during the study period (1991–2010) and were analyzed according to gender.ResultsAmong 16,736 patients who were admitted with ACS, 14262 (85%) were men and 2474 (15%) were women. Cardiovascular risk factors were more prevalent among women in comparison to men. On admission, women presented mainly with non-ST-elevation ACS and were more likely to be undertreated with β-blockers (BB), antiplatelet agents and reperfusion therapy in comparison to men. However, from 1999 through 2010, the use of aspirin, angiotensin-converting enzyme inhibitors and BB increased from 66% to 79%, 27% to 41% and 17% to 49%, respectively in women. In the same period, relative risk reduction for mortality was 64% in women and 51% in men. Across the 20-year period, the mortality rate decreased from 27% to 7% among the Middle Eastern Arab women. Multivariate logistic regression analysis showed that female gender was independent predictor of in-hospital mortality (odd ratio 1.51, 95% CI 1.27–1.79).ConclusionsWomen presenting with ACS are high-risk population and their in-hospital mortality remains higher for all age groups in comparison to men. Although, substantial improvement in the hospital outcome has been observed, guidelines adherence and improvement in the hospital care have not yet been optimized.

Gender difference in treatment and mortality of patients with ST-segment elevation myocardial infarction admitted to Victorian public hospitals: A retrospective database study

“…74 Other international studies have also reported statistically significant mortality rate differences between the sexes. 36,38,47,75 Our findings suggest that over a contemporary 5-year period (2005-2010), a statistically significantly higher proportion of women died of STEMI than men in Victorian public hospitals, which were proportions observably similar to the figures from Leurent's study. 74 We have not found similar mortality proportions previously reported in the Australian population for STEMI.…”

“…33,34 The disparities are not new however, with a number of studies reporting women's tendency to receive less access to reperfusion therapy for STEMI than men. [35][36][37][38] Two papers reporting results from the Australasian ACACIA Registry data have also reported Australian and New Zealand women receive less access to coronary angiography than men. 13,39 Our findings concur that overall, women were less often investigated with angiography than men in Victorian public hospitals, but this was mostly caused by underinvestigation of older women who were the largest group.…”

“…5,6,25 Although this disparity is sometimes discounted when the older average age of women with STEMI is taken into account, 51,52 a number of authors believe age does not adequately account for treatment disparity. 6,36,46,47,53 It may not be reasonable to preclude patients from reperfusion interventions however due to advanced age, as research suggests very elderly patients benefit from such treatment 54 regardless of their sex. 55 Differences in treatment provision may be due to late presentation or diagnosis of ACS in women.…”

Study on Risk Factors and Pattern of Coronary Artery Involvement in Young Acute Coronary Syndrome Patients

“…10,11 CAD is much less frequent in premenopausal women due to the effect of estrogen; as the protection from CAD is much less evident after menopause, the disease affects both sexes equally. 12 In a recent study however, researchers have found that young women who are current smoker and obese are more likely to suffer from ACS.…”

Women-Specific Factors to Consider in Risk, Diagnosis and Treatment of Cardiovascular Disease

“…Women admitted for acute coronary syndromes appear more likely than men to die in the hospital [156], and this risk may be even greater in black women [157]. While reasons are unclear, a coronary artery bypass grafting procedure carries a higher mortality in women than men [158].…”