title: Gender disparities in the presentation, management and outcomes of acute coronary syndrome patients: data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2).
abstract: BACKGROUND
  Gender-related differences in mortality of acute coronary syndrome (ACS) have been reported. The extent and causes of these differences in the Middle-East are poorly understood. We studied to what extent difference in outcome, specifically 1-year mortality are attributable to demographic, baseline clinical differences at presentation, and management differences between female and male patients.
  
  
  RESULTS
  Baseline characteristics, treatment patterns, and 1-year mortality of 7390 ACS patients in 65 hospitals in 6 Arabian Gulf countries were evaluated during 2008-2009, as part of the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2). Women were older (61.3±11.8 vs. 55.6±12.4; P<0.001), more overweight (BMI: 28.1±6.6 vs. 26.7±5.1; P<0.001), and more likely to have a history of hypertension, hyperlipidemia or diabetes. Fewer women than men received angiotensin-converting enzyme inhibitors (ACE), aspirin, clopidogrel, beta blockers or statins at discharge. They also underwent fewer invasive procedures including angiography (27.0% vs. 34.0%; P<0.001), percutaneous coronary intervention (PCI) (10.5% vs. 15.6%; P<0.001) and reperfusion therapy (6.9% vs. 20.2%; P<0.001) than men. Women were at higher unadjusted risk for in-hospital death (6.8% vs. 4.0%, P<0.001) and heart failure (HF) (18% vs. 11.8%, P<0.001). Both 1-month and 1-year mortality rates were higher in women than men (11% vs. 7.4% and 17.3% vs. 11.4%, respectively, P<0.001). Both baseline and management differences contributed to a worse outcome in women. Together these variables explained almost all mortality disparities.
  
  
  CONCLUSIONS
  Differences between genders in mortality appeared to be largely explained by differences in prognostic variables and management patterns. However, the origin of the latter differences need further study.
authors: Department of Internal Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates. a.shehab@uaeu.ac.ae
authors: Abdulla
authors: A
authors: Shehab
authors: Bayan
authors: B
authors: Al-Dabbagh
authors: Khalid F
authors: KF
authors: AlHabib
authors: Alawi A
authors: AA
authors: Alsheikh-Ali
authors: Wael
authors: W
authors: Almahmeed
authors: Kadhim
authors: K
authors: Sulaiman
authors: Ahmed
authors: A
authors: Al-Motarreb
authors: Nicolaas
authors: N
authors: Nagelkerke
authors: Jassim
authors: J
authors: Al Suwaidi
authors: Ahmad
authors: A
authors: Hersi
authors: Hussam
authors: H
authors: Al Faleh
authors: Nidal
authors: N
authors: Asaad
authors: Shukri
authors: S
authors: Al Saif
authors: Haitham
authors: H
authors: Amin
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors