Gender disparities in acute coronary syndrome management and prognosis: National multicenter retrospective cohort study.

Abstract

Background: Gender disparity in the management of cardiovascular disease (CVD) is still significant, leading to suboptimal treatment of acute coronary syndromes (ACS) in women. This study evaluates differences in the management and prognosis of ACS between women and men.

Methods: A multicenter retrospective cohort of 6000 patients with ACS was divided according to the patient's gender. CV risk factors, time to first medical care (FMC), and to electrocardiogram (ECG), coronary angiography (CAG), and percutaneous coronary intervention (PCI) were evaluated. The outcomes assessed were major adverse cardiac events (MACE), in-hospital and follow-up death, referral to cardiac rehabilitation, and hospital readmission.

Results: Of the 6000 patients, 30 % (n = 1784) were female. Women were significantly older (73 ± 13 years vs. 65 ± 13 years, p < 0.001). The time to FMC was longer in women (10.6 h vs. 9.5 h, p < 0.001), and the median time to ECG was similar (101 min vs. 110 min, p = 0.9). Non-ST segment elevation ACS was higher in women [65 % vs 61 % p < 0.001, OR 1.2 (1.1;1.4)]. Women were less likely to undergo CAG [68 % vs. 79 %, p < 0.001, OR 0.6 (0.5;0.7)] and PCI than men [82 % vs. 86 % p < 0.001, OR 0.7 (0.6;0.8)]. Still, unfavorable anatomy cases were comparable (63 % vs 66 %, p = 0.5). Women had less multivessel disease (12 % vs 18 % p < 0.001). Successful PCI was similar among groups (95 % p = 0.9). Women were associated with higher in-hospital death and MACE than men [12 % vs 7 % p < 0.001 OR 1.8 (1.5;2.2) and 7 % vs 5 % p = 0.005, OR 1.5 (1.1;2)]. Women were associated with fewer cardiac rehabilitation referrals [33 % vs 38 % p < 0.001 OR 0.8 (0.7;0.9)]. During the follow-up of 16 ± 7 months, women had a significant association with mortality during follow-up [15 % vs 11 % p < 0.001, OR 1.5 (1.2;1.7)]. Also, women were significantly associated with more hospital readmissions [28 % vs 24 % p = 0.004, OR 1.2 (1.1;1.4)].

Conclusion: Despite enhanced awareness, CVD in women remains underestimated. Women take longer to seek medical care and are less likely to undergo CAG and PCI. This ends in a worse early and long-term prognosis, with higher mortality and MACE on follow-up.