Clinical InvestigationAcute Ischemic Heart DiseaseBridging the gender gap: Insights from a contemporary analysis of sex-related differences in the treatment and outcomes of patients with acute coronary syndromes
Section snippets
Methods
Full details of the Canadian Acute Coronary Syndrome I (ACSI), ACSII, Global Registry of Acute Coronary Events (GRACE/GRACE2), and Canadian Registry of Acute Coronary Events (CANRACE) registries have been published elsewhere.12, 13 Briefly, these were prospective, multicenter, observational studies of patients admitted with ACS in Canada. Both ACSI (1999-2001) and ACSII (2002-2003) enrolled patients ≥18 years old who presented to the hospital within 24 hours of a suspected ACS. In ACSII, only
Study population
A total of 4,874 women and 9,322 men with NSTE-ACS were included in this study. Baseline characteristics of the study population are presented in Table I. Women in these registries were found to be significantly older than men and were more likely to have a history of heart failure, diabetes, or hypertension. Female patients had a higher Killip class than their male counterparts. However, women were less likely to have had a history of revascularization, either with PCI or with CABG, than men.
Discussion
This multicenter observational study demonstrates that gender disparities still exist in the treatment and outcomes of patients with NSTE-ACS in Canada. In the more recent registries, fewer women were treated with thienopyridines, heparin, and GPIIb/IIIa inhibitors compared with men. Female gender was also independently associated with a lower in-hospital use of coronary angiography, even after adjusting for potential confounders. Underestimation of patient risk was the most common reason for
Conclusions
In conclusion, our study found that despite temporal increases in the use of invasive cardiac procedures, women with ACS are still more likely to be treated conservatively compared with their male counterparts. Underestimation of patient risk by the treating physician may be an important reason. Greater awareness of this treatment-risk paradox may help to eliminate the gender gap between our current guidelines and management practices.
Acknowledgements
We thank Sue Francis, BA, for her assistance in the preparation of this manuscript. We are indebted to all the study investigators, coordinators, and patients who participated in the Canadian ACSI, ACSII, GRACE/GRACE2, and CANRACE registries. Dr Andrew Yan is supported by a New Investigator Award from the Heart and Stroke Foundation of Canada.
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On behalf of the Canadian Acute Coronary Syndrome Registries I and II, and the Canadian Global Registry of Acute Coronary Events (GRACE/GRACE2) Investigators. A list of participating Canadian ACS Registry I and II Investigators and Coordinators can be found in Arch Intern Med 2007;167:1009-1016. A list of participating Canadian GRACE and expanded-GRACE investigators and coordinators may be found in Am Heart J 2009;157:642-650.