title: Contemporary treatment and adherence to guidelines in women and men with acute coronary syndromes.
abstract: BACKGROUND
  Historically gender differences existed in treatment and outcome of patients with acute myocardial infarction (MI).
  
  
  OBJECTIVE
  To assess gender aspects of contemporary treatment and adherence to ACC/AHA Class-I Treatment Guidelines in patients with acute coronary syndrome (ACS).
  
  
  METHODS
  We studied 2024 consecutive patients (519 women, 26%); 1026 (51%) with ST-elevation (STE)-MI and 998 (49%) patients with non-STE (NSTE), during a nationwide ACS-survey, conducted during 2-months in 2004.
  
  
  RESULTS
  Women were older than men (71 vs. 59 in STEMI; 71 vs. 64 years in NSTE-ACS patients), and had worse cardiovascular risk profiles. In STEMI-patients, acute reperfusion was less frequent in women than in men (53% vs. 63%, respectively, p=0.01; non-significant after age-adjustment). At discharge, fewer women received ACE-inhibitors/ARBs (71% vs. 75%, respectively; OR(age-adj)=0.69[0.48-0.98]). Among NSTE-ACS patients, fewer women received IIb/IIIa-inhibitors (12% vs. 21%, respectively, p=0.007; OR(age-adj)=0.58[0.36-0.96]) and clopidogrel at discharge (49% vs. 59%, respectively, p=0.005; OR(age-adj) 0.75[0.56-1.01]). No gender differences were noted in utilization of aspirin, beta-blockers or statins. Age-adjusted and covariate-adjusted mortality rates were comparable in women and men with STEMI (at 7-days 4.3% vs. 4.1%; OR(adj)=0.95[0.47-1.87] and at 1-year 13.8% vs. 9.8%, hazard ratio [HR(adj)]=1.11[0.73-1.70], respectively); in women and men with NSTE-ACS (at 7-days 1.3% vs. 2.1%, OR(adj)=0.65[0.20-1.76], and at 1-year 12.0% vs. 11.3%; HR(adj)=1.19[0.80-1.77], respectively).
  
  
  CONCLUSIONS
  In 2004, adherence to ACC/AHA Class-I Treatment Guidelines in ACS-patients was satisfactory. Relative underutilization of acute reperfusion was noted among STEMI patients, without gender differences after age-adjustment. At discharge, less women received ACE-inhibitors/ARBs. Among NSTE-ACS patients, less women than men received IIb/IIIa-inhibitors, and clopidogrel at discharge. Contemporary ACS management was associated with similar adjusted outcome in women and men.
authors.affiliation: Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Mady
authors.initials: M
authors.lastname: Moriel
authors.forename: Dan
authors.initials: D
authors.lastname: Tzivoni
authors.forename: Solomon
authors.initials: S
authors.lastname: Behar
authors.forename: Doron
authors.initials: D
authors.lastname: Zahger
authors.forename: Hanoch
authors.initials: H
authors.lastname: Hod
authors.forename: David
authors.initials: D
authors.lastname: Hasdai
authors.forename: Amir
authors.initials: A
authors.lastname: Sandach
authors.forename: Shmuel
authors.initials: S
authors.lastname: Gottlieb
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection / Q000592:standards / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D012737:Sex Factors; D016896:Treatment Outcome