Abstract
Background: Multiple studies on Non-ST-segment elevation myocardial infarction (NSTEMI) have shown that women tend to have delayed revascularization, with associated worse outcomes, when compared to men. However, there are no studies to date, evaluating the clinical characteristics and outcomes of men versus (vs.) women based on time to revascularization. Methods: The study cohort was obtained from the 2016 Nationwide Readmissions Database. We used the International Classification of Diseases, Tenth Revision, to identify patients who underwent diagnostic angiography and subsequently received either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Finally, mortality and 30-day readmissions rates based on gender and time to revascularization were extracted. Results: In 2016, there were a total of 748,439 weighted admissions for NSTEMI (57% men and 43% women). Compared to men, women were older and had higher percentage of baseline comorbidities. Women tended to be managed less invasively with only 45% undergoing coronary angiogram as compared to 54% in men (p<0.001). Furthermore, there was a difference in revascularization rates, PCI (men 30% vs. women 21%, p<0.001) or CABG (men 10% vs. women 5%, p<0.001). Majority of men (34%) were revascularized by PCI on same day, while majority of women (30%) were revascularized next-day of admission. In both men and women, patients with more comorbidities tend to have delay in revascularization. Compared to men, in-hospital mortality and 30-day readmission is higher in women as the revascularization is delayed (Figure 1). Conclusions: Currently, there exists wide disparity among men and women in the treatment of NSTEMI. Women tend to have worse outcomes as the revascularization gets delayed. Randomized clinical trials are needed to evaluate if a strategy of urgent revascularization (<90 minutes) in women is associated with improved outcomes.
Published Version
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