Differences in the treatment and evolution of acute coronary syndromes according to gender: what are the causes?

Abstract

The objectives of this study were to analyse the differences in the treatment and the evolution of acute coronary syndromes according to the gender of the patient and to determine the likely causes of these differences. Epidemiological studies confirm the differences in the course and treatment of acute coronary syndromes according to factors such as gender and age. The factors associated with the observed gender-based differences are not known. This prospective study was conducted on 596 patients treated in the Hospital Emergency Service of the Hospital Complex of Navarra, Spain, from 1 January 2012 to April 2013 with acute coronary syndromes. A bivariate and logistic analysis has been made by adjusting the age and severity of process to know the differences by gender. A total of 71·8% (n = 428) were men, and the remaining 28·2% (168) were women. The mean age of the men was 66·4 ± 12·7 years, and the mean age of the women was 72·5 ± 13·9 years. We found that antiplatelet drugs (68·4 vs. 22·7%), blockers (70 vs. 25·4%), ACE inhibitors (56·2 vs. 15·6%), fibrinolysis (17·2 vs. 4·5%, p = 0·025) and primary angioplasty (AP) (38·7 vs. 16·3%, p = 0·008) were less frequently administered to women compared with men. We observed an additional delay in the demand for health care in women with acute coronary syndromes compared with men. There is an association between treatment differences and gender. The delay in the request of health care in women is observed to be the largest correlating factor, in addition to voluntary discharge in women affected by acute coronary syndromes. Delays in seeking medical care or voluntary discharge are likely factors related to worse outcomes in women. These factors should be explored, and the results should be made available to the public, particularly to women.