title: Delay in invasive risk stratification of women with acute coronary syndrome is associated with worse outcomes.
abstract: BACKGROUND
  Invasive risk stratification in patients with acute coronary syndromes (ACS) has been shown to improve outcomes. There is paucity of data on women undergoing invasive risk stratification. We investigated whether the time to coronary angiography affects survival of female patients admitted with ACS.
  
  
  METHODS
  Female patients admitted to the coronary intensive care unit with ACS between 1/1/97 and 12/31/00 and undergoing coronary angiography during same hospitalization were divided into three groups based on the time to angiography: same day, 1-2 days and >2 days. The baseline clinical features, angiography results and outcomes were compared between the angiography groups.
  
  
  RESULTS
  Of the total 350 female patients who fulfilled the inclusion criteria, 63% underwent angiography within two days of presentation. Three year mortality rates in women undergoing angiography on the same day, 1-2 days and >2-days were 7%, 7% and 22% respectively (p = 0.001). Using multivariate analysis, angiography beyond 2 days was a significant predictor of mortality among women (OR 2.6, 95% CI 1.3-5.0, p = 0.006) after adjusting for confounding variables.
  
  
  CONCLUSIONS
  Later invasive risk stratification after 2 days of presentation in women with ACS is associated with worse survivial. Gender should not be a reason to defer early coronary angiography in these patients.
authors.affiliation: Henry Ford Heart & Vascular Institute, Detroit, MI, USA. malmall1@hfhs.org
authors.forename: Mouaz Husayn
authors.initials: MH
authors.lastname: Al-Mallah
authors.forename: Rasha N
authors.initials: RN
authors.lastname: Bazari
authors.forename: Sanjaya
authors.initials: S
authors.lastname: Khanal
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003325:Coronary Care Units; D005260:Female; D006801:Humans; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors