Gender inequality in the clinical outcomes of equally treated acute coronary syndrome patients in Saudi Arabia.
OBJECTIVE
Gender associations with acute coronary syndrome (ACS), remain inconsistent. Gender-specific data in the Saudi Project for Assessment of Coronary Events registry, launched in December 2005 and currently with 17 participating hospitals, were explored.


METHODS
A prospective multicenter study of patient with ACS in secondary and tertiary care centers in Saudi Arabia were included in this analysis.


METHODS
Patients enrolled from December 2005 until December 2007 included those presented to participating hospitals or transferred from non-registry hospitals. Summarized data were analyzed.


RESULTS
Of 5061 patients, 1142 (23%) were women. Women were more frequently diagnosed with non ST-segment elevation myocardial infarction (NSTEMI [43%]) than unstable angina (UA [29%]) or ST-segment elevation myocardial infarction (STEMI [29%]). More men had STEMI (42%) than NSTEMI (37%) or UA (22%). Men were younger than women (57 vs 63 years) who had more diabetes, hypertension, and hyperlipidemia. More men had a history of coronary artery disease. More women received angiotensin receptor blockers (ARB) and fewer had percutaneous coronary intervention (PCI). Gender differences in the subset of STEMI patients were similar to those in the entire cohort. However, gender differences in the subset of STEMI showed fewer women given b-blockers, and an insignificant PCI difference between genders. Thrombolysis rates between genders were similar. Overall, in-hospital mortality was significantly worse for women and, by ACS type, was significantly greater in women for STEMI and NSTEMI. However, after age adjustment there was no difference in mortality between men and women in patients with NSTEMI. The multivariate-adjusted (age, risk factors, treatments, door-to-needle time) STEMI gender mortality difference was not significant (OR=2.0, CI: 0.7-5.5; P=.14).


CONCLUSIONS
These data are similar to other reported data. However, differences exist, and their explanation should be pursued to provide a valuable insight into understanding ACS and improving its management.
Dr. Ahmad Hersi, Colllege of Medicine,, King Saud University,, Cardaic Science,, King Khalid University Hospital,, Riyadh 11472, Saudi Arabia, ahersi@ksu.edu.sa.
Ahmad
A
Hersi
Khalid
K
Al-Habib
Husam
H
Al-Faleh
Khalid
K
Al-Nemer
Shukri
S
Alsaif
Amir
A
Taraben
Tarek
T
Kashour
Ahmed Mohamed
AM
Abuosa
Mushabab Ayedh
MA
Al-Murayeh
D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D054624:Health Status Disparities; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012529:Saudi Arabia; D012737:Sex Factors; D016896:Treatment Outcome