Gender differences in the presentation and management of acute coronary syndromes: a national sample of 1365 admissions.

Frank Doyle, Royal College of Surgeons in Ireland
Davida De La Harpe, Royal College of Surgeons in Ireland
Hannah McGee, Royal College of Surgeons in Ireland
Emer Shelley, Royal College of Surgeons in Ireland
Ronán Conroy, Royal College of Surgeons in Ireland

Document Type Article

This article is available at http://journals.lww.com/ejcpr. The repository version is not the final published version.

Abstract

BACKGROUND: Gender differences in presentation and management of acute coronary syndromes (ACS) are well established internationally. This study investigated differences in a national Irish sample. DESIGN: Cross-sectional survey. METHODS: All centres (n=39) admitting cardiac patients to intensive/coronary care provided information on 25 consecutive acute myocardial infarction patients and other ACS patients admitted concurrently (n=1365 episodes). Patient data was analyzed in terms of those with prior ACS/revascularization, and those without. RESULTS: Men with prior established ACS/revascularization were twice as likely to have received revascularization procedures (coronary artery bypass graft or percutaneous coronary intervention) prior to admission when controlling for age, total cholesterol and insurance status [odds ratio (OR) 1.97, 95% confidence interval (CI) 1.18-3.29, P=0.011]. No gender differences were seen in acute-phase reperfusion (OR 0.96, 95% CI 0.76-1.24, P>0.05) or antiplatelet therapy (OR 0.99, 95% CI 0.69-1.41, P>0.05). For patients with prior ACS/revascularization, men were twice as likely to receive statins on discharge after adjustment for age and total cholesterol (OR 1.94, 95% CI 1.02-3.71, P=0.045). CONCLUSIONS: Women were treated differently to men. Fewer women with a positive history of ACS received revascularization prior to current admission and fewer women were prescribed lipid-lowering medications on discharge. Acute phase hospital treatment was not gender determined. These findings have implications for secondary prevention in Ireland.