Sex and gender differences in presentation, treatment and outcomes in acute coronary syndrome, a 10 year study from a multi-ethnic Asian population: The Malaysian National Cardiovascular Disease Database—Acute Coronary Syndrome (NCVD-ACS) registry

Abstract

Background Sex and gender differences in acute coronary syndrome (ACS) have been well studied in the western population. However, limited studies have examined the trends of these differences in a multi-ethnic Asian population. Objectives To study the trends in sex and gender differences in ACS using the Malaysian NCVD-ACS Registry. Methods Data from 24 hospitals involving 35,232 ACS patients (79.44% men and 20.56% women) from 1st. Jan 2012 to 31st. Dec 2016 were analysed. Data were collected on demographic characteristics, coronary risk factors, anthropometrics, treatments and outcomes. Analyses were done for ACS as a whole and separately for ST-segment elevation myocardial infarction (STEMI), Non-STEMI and unstable angina. These were then compared to published data from March 2006 to February 2010 which included 13,591 ACS patients (75.8% men and 24.2% women). Results Women were older and more likely to have diabetes mellitus, hypertension, dyslipidemia, previous heart failure and renal failure than men. Women remained less likely to receive aspirin, beta-blocker, angiotensin-converting enzyme inhibitor (ACE-I) and statin. Women were less likely to undergo angiography and percutaneous coronary intervention (PCI) despite an overall increase. In the STEMI cohort, despite a marked increase in presentation with Killip class IV, women were less likely to received primary PCI or fibrinolysis and had longer median door-to-needle and door-to-balloon time compared to men, although these had improved. Women had higher unadjusted in-hospital, 30-Day and 1-year mortality rates compared to men for the STEMI and NSTEMI cohorts. After multivariate adjustments, 1-year mortality remained significantly higher for women with STEMI (adjusted OR: 1.31 (1.09–1.57), p<0.003) but were no longer significant for NSTEMI cohort. Conclusion Women continued to have longer system delays, receive less aggressive pharmacotherapies and invasive treatments with poorer outcome. There is an urgent need for increased effort from all stakeholders if we are to narrow this gap.

The Effect of Periprocedural Clinical Factors Related to the Course of STEMI in Men and Women Based on the National Registry of Invasive Cardiology Procedures (ORPKI) between 2014 and 2019

“…The women in the study group were older and more often had diabetes, hypertension, heart failure, and renal failure than the men. Among the women, there was a higher rate of in-hospital, 30-day, and annual mortality in both the STEMI and NSTEMI groups [ 23 ]. Women have a higher risk for thrombotic and bleeding events compared to men.…”

Intervention and in-hospital pharmacoterapies in octogenarian with acute coronary syndrome: a 10-year retrospective analysis of the Malaysian National Cardiovascular Database (NCVD) registry

“…Variations of in-hospital management for different groups of interest according to demographics, risk factors and co-morbidities were analysed using multivariate logistic regression, presented as adjusted odds ratio (aOR) with a 95% confidence interval (CI). The choice of covariates was based on factors influencing ACS management in the literature and included gender, ethnicity, types of ACS, risk factors and co-morbidities [ 22 ]. A probability ( p ) value of less than 0.05 is considered statistically significant.…”

Impact of Gender on the Clinical Features, Angiographic Findings, and Outcomes of Young Patients Presented With Acute Coronary Syndrome

“…7 The few studies that looked into gender differences among ACS patients showed that women had an atypical presentation and that they often took longer to seek medical care, both of which act as contributory factors in delaying appropriate management. 8 Qinghua et al reported a higher incidence of unstable angina and thrombolysis in myocardial infarction (TIMI) III flow in women but with a higher mortality both inhospital and in the long-term follow-up. 9 The Gulf RACE-I study, which was conducted in 2007, including six Middle Eastern countries, showed that mortality among women with ACS was higher than among men.…”