Abstract
BackgroundStudies from high-income countries have shown that women receive less aggressive diagnostics and treatment than men in acute coronary syndromes (ACS), though their short-term mortality does not appear to differ from men. Data on gender differences in ACS presentation, management, and outcomes are sparse in India.Methods and ResultsThe Detection and Management of Coronary Heart Disease (DEMAT) Registry collected data from 1,565 suspected ACS patients (334 women; 1,231 men) from ten tertiary care centers throughout India between 2007–2008. We evaluated gender differences in presentation, in-hospital and discharge management, and 30-day death and major adverse cardiovascular event (MACE; death, re-hospitalization, and cardiac arrest) rates. Women were less likely to present with STEMI than men (38% vs. 55%, p<0.001). Overall inpatient diagnostics and treatment patterns were similar between men and women after adjustment for potential confounders. Optimal discharge management with aspirin, clopidogrel, beta-blockers, and statin therapy was lower for women than men, (58% vs. 65%, p = 0.03), but these differences were attenuated after adjustment (OR = 0.86 (0.62, 1.19)). Neither the outcome of 30-day mortality (OR = 1.40 (0.62, 3.16)) nor MACE (OR = 1.00 (0.67, 1.48)) differed significantly between men and women after adjustment.ConclusionsACS in-hospital management, discharge management, and 30-day outcomes did not significantly differ between genders in the DEMAT registry, though consistently higher treatment rates and lower event rates in men compared to women were seen. These findings underscore the importance of further investigation of gender differences in cardiovascular care in India.
Highlights
India experienced more than 2.3 million deaths in 2008 due to cardiovascular diseases (CVD), and more than half of these deaths (1.3 million) were due to ischemic heart disease [1]
acute coronary syndromes (ACS) in-hospital management, discharge management, and 30-day outcomes did not significantly differ between genders in the DEMAT registry, though consistently higher treatment rates and lower event rates in men compared to women were seen
The CREATE registry of over 20,000 ACS patients across 89 centers in India showed that 30-day mortality for patients with ST-elevation myocardial infarction (STEMI) and for those with non-STEMI
Summary
India experienced more than 2.3 million deaths in 2008 due to cardiovascular diseases (CVD), and more than half of these deaths (1.3 million) were due to ischemic heart disease [1]. Differences in gender are important to investigate because studies from high-income countries have repeatedly shown that women present differently and receive less intensive diagnostic and therapeutic management than men for ACS [3,4,5,6,7,8,9,10]. Differences in the rate of reperfusion therapy and coronary angiography between men and women have not narrowed between 1994 and 2002 in the US [11] Despite these differences in process of care measures, most studies have not shown any significant difference in outcomes between men and women, especially after adjustment for potential confounders [3,5,9,10]. Studies from high-income countries have shown that women receive less aggressive diagnostics and treatment than men in acute coronary syndromes (ACS), though their short-term mortality does not appear to differ from men. Data on gender differences in ACS presentation, management, and outcomes are sparse in India
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