Gender differences in the management and outcomes of acute coronary syndrome in indians: A systematic review and meta-analysis

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal Pub Date : 2024-09-01 DOI:10.1016/j.ihj.2024.10.002

Deep Dutta , Kunal Mahajan , Lokesh Verma , Gunjan Gupta , Meha Sharma

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引用次数: 0

Abstract

Background

Gender differences in acute coronary syndrome (ACS) outcomes have been noted in global data, which however did not analyse Indian data. No prior systematic review and meta-analysis (SRM) has addressed this important aspect of gender bias in Indian women with ACS. Hence this SRM aimed to address this knowledge gap.

Methods

Electronic databases were searched for studies in ACS comparing cardiovascular disease presentation, treatment received and outcomes in women and men from India. Primary outcomes were to evaluate gender-differences in 30-day death and major adverse cardiovascular events (MACE). Secondary outcomes were to evaluate gender-differences in presentation, management and mortality. The SRM is registered with PROSPERO (CRD42023477286).

Results

From initially screened 3753 articles, data from 9 studies (61,185 patients) were analysed. Women with ACS had higher prevalence of diabetes [Odds ratio (OR) 1.65(95%CI:1.33–2.04); p < 0.001; I² = 95 %] and hypertension [OR2.06(95%CI:1.88–2.25); p < 0.001; I² = 42 %]. Smoking was significantly lower in women [OR 0.05(95%CI:0.03–0.07); p < 0.001; I² = 87 %]. Non-ST elevation myocardial infarction (NSTEMI) was significantly higher in women [OR 1.92(95%CI:1.66–2.21); p < 0.001; I² = 0 %]. Diagnostic angiography [OR 0.64(95%CI:0.56–0.74); p < 0.001; I² = 46 %] and percutaneous coronary interventions [OR0.71(95%CI:0.55–0.92); p = 0.01; I² = 92 %] were significantly lower in women. Women had significantly higher 30-day mortality [Hazard ratio (HR)2.26(95%CI:2.01–2.55); p < 0.001; I² = 6 %], 1-year mortality [HR2.41(95%CI:1.89–3.07); p < 0.001; I² = 53 %], in-hospital death [HR1.88(95%CI:1.19–2.96); p = 0.007; I² = 92 %], stroke [HR 1.84 (95%CI:1.34–2.52); p < 0.001; I² = 0 %] and MACE outcomes [OR 2.05 (95%CI:1.78–2.35); p < 0.001]. Use of aspirin, clopidogrel, beta-blockers and nitrates were significantly lower in women.

Conclusion

Our study highlights worse outcomes in Indian women with ACS. Higher burden of diabetes and hypertension, decreased used of PCI and lesser aggressive pharmacotherapy may be some of the contributing factors.

查看原文本刊更多论文

印度人急性冠状动脉综合征管理和预后的性别差异：系统回顾和荟萃分析。

背景：全球数据显示，急性冠状动脉综合征（ACS）结果存在性别差异，但这些数据并未对印度数据进行分析。之前没有系统综述和荟萃分析（SRM）涉及印度女性急性冠脉综合征患者的性别偏差这一重要方面。因此，本SRM旨在填补这一知识空白：方法：在电子数据库中搜索关于 ACS 的研究，比较印度女性和男性心血管疾病的表现、接受的治疗和结果。主要结果是评估 30 天死亡和主要不良心血管事件（MACE）的性别差异。次要结果是评估发病、治疗和死亡率方面的性别差异。SRM 已在 PROSPERO 注册（CRD42023477286）：结果：从初步筛选的 3753 篇文章中，分析了来自 9 项研究（61185 名患者）的数据。患有 ACS 的女性糖尿病[比值比 (OR) 1.65(95%CI:1.33-2.04);P2=95%] 和高血压[OR2.06(95%CI:1.88-2.25);P2=42%]患病率较高。女性吸烟率明显较低[OR 0.05（95%CI：0.03-0.07）；P2=87%]。女性非 ST 段抬高型心肌梗死（NSTEMI）患者明显较多[OR 1.92(95%CI:1.66-2.21);P2=0%] 。诊断性血管造影[OR 0.64(95%CI:0.56-0.74);P2=46%] 和经皮冠状动脉介入治疗[OR0.71(95%CI:0.55-0.92);P=0.01;I2=92%]在女性中明显较低。女性的 30 天死亡率[危险比（HR）2.26（95%CI：2.01-2.55）；P2=6%]、1 年死亡率[HR2.41（95%CI：1.89-3.P2=53%]、院内死亡[HR1.88(95%CI:1.19-2.96);P=0.007;I2=92%]、卒中[HR1.84(95%CI:1.34-2.52);P2=0%]和MACE结局[OR2.05(95%CI:1.78-2.35);PC结论：我们的研究表明，印度女性ACS患者的预后更差。糖尿病和高血压的发病率较高、PCI的使用率较低以及药物治疗的积极性较低可能是部分原因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Indian heart journal CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.60

自引率

6.70%

发文量

审稿时长

52 days

期刊介绍： Indian Heart Journal (IHJ) is the official peer-reviewed open access journal of Cardiological Society of India and accepts articles for publication from across the globe. The journal aims to promote high quality research and serve as a platform for dissemination of scientific information in cardiology with particular focus on South Asia. The journal aims to publish cutting edge research in the field of clinical as well as non-clinical cardiology - including cardiovascular medicine and surgery. Some of the topics covered are Heart Failure, Coronary Artery Disease, Hypertension, Interventional Cardiology, Cardiac Surgery, Valvular Heart Disease, Pulmonary Hypertension and Infective Endocarditis. IHJ open access invites original research articles, research briefs, perspective, case reports, case vignette, cardiovascular images, cardiovascular graphics, research letters, correspondence, reader forum, and interesting photographs, for publication. IHJ open access also publishes theme-based special issues and abstracts of papers presented at the annual conference of the Cardiological Society of India.