Contemporary treatment and adherence to guidelines in women and men with acute coronary syndromes.
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.
Moriel
Mady
M
Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel.
Tzivoni
Dan
D
Behar
Solomon
S
Zahger
Doron
D
Hod
Hanoch
H
Hasdai
David
D
Sandach
Amir
A
Gottlieb
Shmuel
S
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