GENDER AFFECTS CARE AND PROGNOSIS IN ACUTE CORONARY SYNDROME

Therapeutic Area

ASCD/CVD in Women

Background

This study evaluates possible differences in prognosis in acute coronary syndrome (ACS) based on gender of the patient, analyzing data from the National Myocardial Infarction Register in Hungary. The data include 76,153 ACS patients followed over five years. The study evaluates all-cause mortality, risk factors, and treatment outcomes. All cause mortality was assessed at 30 days, 1 year, and 5 years.

Methods

The data set analyzed is the result of mandatory reporting of data on patients presenting with ACS to hospitals in Hungary, in effect from January 2014 on forward. Data on 155,000 encounters involving over 130,000 patients were collected by September 2022. The current study comprises a retrospective analysis of all cases reported to the registry from its date of inception (January 1st, 2014) to 2019. The primary outcome measured was all-cause mortality.

Results

The analyzed patient cohort had a median age of 67.4 years, 60% of patients entered were males. Key patient characteristics included a 34% prevalence of diabetes and an 18% history of previous ACS, 44% of the patients presented with ST elevation myocardial infarction (STEMI) during their initial admission, and 77% were admitted directly to hospitals with percutaneous coronary intervention (PCI) capability. There was a 12.1% short-term (30 day), a 21.5% mid-term (one year), and a 37% long-term (five year) all-causemortality rate across the cohort. Both short- term and long-term mortality rates were influenced significantly by age, diabetes, and whether the patient’s ACS presentation was caused by a STEMI versus a non ST elevation myocardial infarction (NSTEMI). Women presented with a less favourable cardiovascular risk profile, characterized by higher rates of diabetes, hypertension, and older age. Men had a higher incidence of prior cardiac interventions, they notably received more timely treatment compared to women, and they were more likely to undergo PCI. Further, women experienced higher rates of complications during treatment and they were less likely to receive guideline consistent drug therapy at discharge.

Conclusions

Our results demonstrate gender-related disparities in key parameters relating to presentation, triaging, and treatment modality chosen in patients presenting with ACS. Physiological gender related patient differences alone cannot explain these disparities. We believe that unconscious bias and knowledge deficits regarding the more diverse and atypical presentation patterns of female ACS patients likely affect decision makers at all levels (patients themselves, physicians, and allied health professionals). Such unconscious bias and knowledge deficits should be the target of educational campaigns directed at the public and at health care professionals.