Systematic Review and Meta-analyses Investigating Whether Risk Stratification Explains Lower Rates of Coronary Angiography Among Women With Non–ST-Segment Elevation Acute Coronary Syndrome

Worrall‐Carter, Linda; McEvedy, Samantha; Kühn, Lisa; Scruth, Elizabeth; MacIsaac, Andrew; Rahman, Muhammad Aziz

doi:10.1097/jcn.0000000000000300

Cited by 10 publications

(11 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The underestimation of risk in females has been proposed as a reason for lower rates of angiography in women [8,16]. In a recent systematic review, we were able to demonstrate that females with NSTEACS were more likely to be stratified high-risk than males, and drew attention to a previously described treatment-risk paradox, whereby patients with lower risk are more likely to be referred for angiography [23][24][25]. In an attempt to explain lower rates of angiography in women, we further hypothesized that females may be more likely to have severe comorbidities which preclude the use of angiography.…”

Section: Discussionmentioning

confidence: 63%

Impact of comorbidities and gender on the use of coronary interventions in patients with high-risk non-ST-segment elevation acute coronary syndrome

Worrall‐Carter

McEvedy

Wilson

et al. 2015

Heart, Lung and Circulation

View full text Add to dashboard Cite

Objectives: To determine the impact of gender and comorbidity on use of coronary interventions in patients diagnosed with high-risk non-ST-segment acute coronary syndrome (NSTEACS). Background: Guidelines recommend the use of coronary angiography for all patients diagnosed with NSTEACS with high-risk features, except in the presence of severe comorbidities. However, little is understood about the relationship between gender, comorbidity, and the use of coronary interventions. Methods: Retrospective analyses of the Victorian Admitted Episodes Data Set (VAED) including all patients diagnosed with NSTEACS with high-risk features on their first admission for ACS between June 2007 and July 2009. Hierarchical logistic regression models and correspondence analyses were used to understand the relationship between gender, comorbidities, and the use of coronary interventions. Results: Out of 16,771 NSTEACS patients with high-risk features, 6,338 (38%) were female. Females were older than males (aged 75: 62% vs 39%, p < 0.001) and more likely to have multiple comorbidities (2: 66% vs 59%, p < 0.001). After adjusting for potential confounders, females were more likely to receive no coronary intervention than males with a similar number of comorbid conditions (no comorbidities: OR 1.62, 95% CI 1.28-2.05; 1 comorbidity: OR 1.67, 95% CI 1.44-1.93; 2 comorbidities: OR 1.93, 95% CI 1.66-2.23; 3 comorbidities: OR 1.42, 95% CI 1.27-1.60). Conclusions: Lower rates of coronary intervention in females persisted after adjusting for number of comorbidities which suggests that gender may bias decisions regarding referral for coronary intervention in high-risk NSTEACS independent of other factors. V C 2015 Wiley Periodicals, Inc.

show abstract

Section: Discussionmentioning

confidence: 63%

Impact of comorbidities and gender on the use of coronary interventions in patients with high-risk non-ST-segment elevation acute coronary syndrome

Worrall‐Carter

McEvedy

Wilson

et al. 2015

Heart, Lung and Circulation

View full text Add to dashboard Cite

show abstract

“…The underestimation of risk in females has been proposed as a reason for lower rates of angiography in women . In a recent systematic review, we were able to demonstrate that females with NSTEACS were more likely to be stratified high‐risk than males, and drew attention to a previously described treatment‐risk paradox, whereby patients with lower risk are more likely to be referred for angiography . In an attempt to explain lower rates of angiography in women, we further hypothesized that females may be more likely to have severe comorbidities which preclude the use of angiography.…”

Section: Discussionmentioning

confidence: 93%

Impact of comorbidities and gender on the use of coronary interventions in patients with high‐risk non‐ST‐segment elevation acute coronary syndrome

Worrall‐Carter

McEvedy

Wilson

et al. 2015

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

show abstract

“…ACS remains a diagnostic challenge because no single risk stratification model (e.g., Thrombolysis in Myocardial Infarction [TIMI] risk score; history, ECG, age, risk factors, Troponin [HEART] score) or diagnostic strategy has been shown to identify all ACS cases accurately and there is no clear reference standard (Cullen et al, ; Fanaroff et al, ; Worrall‐Carter et al, ). Findings from prior studies suggest that patients presenting with chest symptoms (chest pain, chest pressure, or chest discomfort) have a high likelihood of an ACS diagnosis and certain clinical features (e.g., pulmonary basal crackles, hypotension) can predict ACS, but neither alone can confirm an ACS diagnosis (Body et al, ; DeVon, Rosenfeld, Steffen, & Daya, ).…”

Section: Introductionmentioning

confidence: 99%

Patient‐reported symptoms improve prediction of acute coronary syndrome in the emergency department

Zègre‐Hemsey

Burke

DeVon

2018

Research in Nursing & Health

View full text Add to dashboard Cite

Early diagnosis is critical in the management of patients with acute coronary syndrome (ACS), particularly ST-elevation myocardial infarction (STEMI), because effective therapies are time-dependent. Aims of this secondary analysis were to determine: (i) the prognostic value of symptoms for an ACS diagnosis in conjunction with electrocardiographic (ECG) and troponin results; and (ii) if any of 13 symptoms were associated with prehospital delay in those presenting to the emergency department (ED) with potential ACS. Patients receiving a cardiac evaluation in the ED were eligible for the study. Thirteen patient-reported symptoms were assessed in triage. Prehospital delay time was calculated as the time from symptom onset until registration in the ED. A total of 1,064 patients were enrolled in five EDs. The sample was 62% male, 70% white, and had a mean age of 60.2 years. Of 474 participants diagnosed with ACS, 118 (25%) had STEMI; 251 (53%) had non-ST elevation myocardial infarction (NSTEMI); and 105 (22%) had unstable angina. Sweating (OR = 1.42 CI [1.01, 2.00]) and shoulder pain (OR = 1.64 CI [1.13, 2.38]) added to the predictive value of an ACS diagnosis when combined with ECG and troponin results. Shortness of breath (OR = 0.71 CI [0.50, 1.00]) and unusual fatigue (OR = 0.60 CI [0.42, 0.84]) were predictive of a non-ACS diagnosis. Sweating predicted shorter prehospital delay (HR = 1.35, CI [1.10, 1.67]); shortness of breath (HR = 0.73 CI [0.60, 0.89]) and unusual fatigue (HR = 0.72, CI [0.57, 0.90]) were associated with longer prehospital delay. Patient-reported symptoms are significantly associated with ACS diagnoses and prehospital delay. Sweating and shoulder pain combined with ECG signs of ischemia may improve the timely detection of ACS in the ED.

show abstract

Systematic Review and Meta-analyses Investigating Whether Risk Stratification Explains Lower Rates of Coronary Angiography Among Women With Non–ST-Segment Elevation Acute Coronary Syndrome

Cited by 10 publications

References 57 publications

Impact of comorbidities and gender on the use of coronary interventions in patients with high-risk non-ST-segment elevation acute coronary syndrome

Impact of comorbidities and gender on the use of coronary interventions in patients with high-risk non-ST-segment elevation acute coronary syndrome

Impact of comorbidities and gender on the use of coronary interventions in patients with high‐risk non‐ST‐segment elevation acute coronary syndrome

Patient‐reported symptoms improve prediction of acute coronary syndrome in the emergency department

Contact Info

Product

Resources

About