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Bridging the gender gap: Insights from a contemporary analysis of sex-related differences in the treatment and outcomes of patients with acute coronary syndromes.
Am Heart J. 2012 Jan; 163(1):66-73.AH

Abstract

BACKGROUND

The question of whether gender-related disparities still exist in the treatment and outcomes of patients presenting with acute coronary syndromes (ACS) remains controversial. Using data from 4 registries spanning a decade, we sought to determine whether sex-related differences have persisted over time and to examine the treating physician's rationale for adopting a conservative management strategy in women compared with men.

METHODS

From 1999 to 2008, 14,196 Canadian patients with non-ST-segment elevation ACS were recruited into the Acute Coronary Syndrome I (ACSI), ACSII, Global Registry of Acute Coronary Events (GRACE/GRACE(2)), and Canadian Registry of Acute Coronary Events (CANRACE) prospective multicenter registries.

RESULTS

Women in the study population were found to be significantly older than men and were more likely to have a history of heart failure, diabetes, or hypertension. Fewer women were treated with thienopyridines, heparin, and glycoprotein IIb/IIIa inhibitors compared with men in GRACE and CANRACE. Female gender was independently associated with a lower in-hospital use of coronary angiography (adjusted odds ratio 0.76, 95% CI 0.69-0.84, P < .001) and higher in-hospital mortality (adjusted odds ratio 1.26, 95% CI 1.02-1.56, P = .036), irrespective of age (P for interaction =.76). Underestimation of patient risk was the most common reason for not pursuing an invasive strategy in both men and women.

CONCLUSIONS

Despite temporal increases in the use of invasive cardiac procedures, women with ACS are still more likely to be treated conservatively, which may be due to underestimation of patient risk. Furthermore, they have worse in-hospital outcomes. Greater awareness of this paradox may assist in bridging the gap between current guidelines and management practices.

Authors+Show Affiliations

Terrence Donnelly Heart Centre, Division of Cardiology, St Michael's Hospital, University of Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22172438

Citation

Poon, Stephanie, et al. "Bridging the Gender Gap: Insights From a Contemporary Analysis of Sex-related Differences in the Treatment and Outcomes of Patients With Acute Coronary Syndromes." American Heart Journal, vol. 163, no. 1, 2012, pp. 66-73.
Poon S, Goodman SG, Yan RT, et al. Bridging the gender gap: Insights from a contemporary analysis of sex-related differences in the treatment and outcomes of patients with acute coronary syndromes. Am Heart J. 2012;163(1):66-73.
Poon, S., Goodman, S. G., Yan, R. T., Bugiardini, R., Bierman, A. S., Eagle, K. A., Johnston, N., Huynh, T., Grondin, F. R., Schenck-Gustafsson, K., & Yan, A. T. (2012). Bridging the gender gap: Insights from a contemporary analysis of sex-related differences in the treatment and outcomes of patients with acute coronary syndromes. American Heart Journal, 163(1), 66-73. https://doi.org/10.1016/j.ahj.2011.09.025
Poon S, et al. Bridging the Gender Gap: Insights From a Contemporary Analysis of Sex-related Differences in the Treatment and Outcomes of Patients With Acute Coronary Syndromes. Am Heart J. 2012;163(1):66-73. PubMed PMID: 22172438.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bridging the gender gap: Insights from a contemporary analysis of sex-related differences in the treatment and outcomes of patients with acute coronary syndromes. AU - Poon,Stephanie, AU - Goodman,Shaun G, AU - Yan,Raymond T, AU - Bugiardini,Raffaele, AU - Bierman,Arlene S, AU - Eagle,Kim A, AU - Johnston,Nina, AU - Huynh,Thao, AU - Grondin,Francois R, AU - Schenck-Gustafsson,Karin, AU - Yan,Andrew T, PY - 2011/07/07/received PY - 2011/09/27/accepted PY - 2011/12/17/entrez PY - 2011/12/17/pubmed PY - 2012/2/11/medline SP - 66 EP - 73 JF - American heart journal JO - Am Heart J VL - 163 IS - 1 N2 - BACKGROUND: The question of whether gender-related disparities still exist in the treatment and outcomes of patients presenting with acute coronary syndromes (ACS) remains controversial. Using data from 4 registries spanning a decade, we sought to determine whether sex-related differences have persisted over time and to examine the treating physician's rationale for adopting a conservative management strategy in women compared with men. METHODS: From 1999 to 2008, 14,196 Canadian patients with non-ST-segment elevation ACS were recruited into the Acute Coronary Syndrome I (ACSI), ACSII, Global Registry of Acute Coronary Events (GRACE/GRACE(2)), and Canadian Registry of Acute Coronary Events (CANRACE) prospective multicenter registries. RESULTS: Women in the study population were found to be significantly older than men and were more likely to have a history of heart failure, diabetes, or hypertension. Fewer women were treated with thienopyridines, heparin, and glycoprotein IIb/IIIa inhibitors compared with men in GRACE and CANRACE. Female gender was independently associated with a lower in-hospital use of coronary angiography (adjusted odds ratio 0.76, 95% CI 0.69-0.84, P < .001) and higher in-hospital mortality (adjusted odds ratio 1.26, 95% CI 1.02-1.56, P = .036), irrespective of age (P for interaction =.76). Underestimation of patient risk was the most common reason for not pursuing an invasive strategy in both men and women. CONCLUSIONS: Despite temporal increases in the use of invasive cardiac procedures, women with ACS are still more likely to be treated conservatively, which may be due to underestimation of patient risk. Furthermore, they have worse in-hospital outcomes. Greater awareness of this paradox may assist in bridging the gap between current guidelines and management practices. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/22172438/Bridging_the_gender_gap:_Insights_from_a_contemporary_analysis_of_sex_related_differences_in_the_treatment_and_outcomes_of_patients_with_acute_coronary_syndromes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(11)00711-3 DB - PRIME DP - Unbound Medicine ER -