Is sex a factor in determining whether acute coronary syndrome patients with renal insufficiency undergo diagnostic cardiac catheterization?

Abstract

Study objectives: Multiple authors have reported that treating physicians are less aggressive in the evaluation of acute coronary syndromes (ACS) in women compared with men. We suspect that if there were a higher risk-benefit ratio, the bias toward more aggressive evaluations in men would be greater. We attempt to determine whether women with a history of chronic renal insufficiency (CRI) who present to the emergency department (ED) with ACS undergo diagnostic cardiac catheterization as frequently as men with CRI and ACS. Methods: We performed an institutional review board–approved, retrospective medical record review of patients who presented to 2 EDs with symptoms of ACS. Trained reviewers extracted data in a standardized format. Demographic information, laboratory data, and hospital course were recorded. Fisher's exact test and Student's t test were used to analyze the data. This study was conducted at 2 EDs (a suburban academic teaching hospital and a community hospital). Data were collected from a departmental Performance Improvement initiative. Results: Between February 2002 and September 2003, a total of 493 (302 from a university teaching hospital and 191 from a community hospital) consecutive patient records with the diagnosis of ACS were reviewed. Forty-six percent (70/151) of men and 33% (50/151) of women underwent catheterization. There were 20 men and 11 women with a history of renal insufficiency. One patient was excluded because of a lack of complete data. Forty-five percent (9/20) of men with CRI underwent diagnostic cardiac catheterization. No (0/10) women with CRI underwent catheterization ( P =.01). Patients who were younger underwent percutaneous intervention more frequently (catheterization: age 70.0 years, 95% confidence interval [CI] 63.8 to 76.2 years; no catheterization: age 79.1 years, 95% CI 74.9 to 83.2 years; P =.02). There were no statistical differences of creatinine levels between men and women or between patients who did and did not undergo catheterization. Conclusion: There was a significant difference in the rates of diagnostic cardiac catheterization between men and women with ACS and CRI. No women with ACS and CRI underwent catheterization. Future studies will need to investigate why this group did not undergo catheterization.