title: Recent temporal trends in the presentation, management, and outcome of women hospitalized with acute coronary syndromes.
abstract: BACKGROUND
  Few data exist on the recent trends in the outcome of women hospitalized with acute coronary syndrome. We examined temporal trends in the hospital management and outcomes of women hospitalized with acute coronary syndrome in a real-world setting.
  
  
  METHODS
  We evaluated time-dependent changes in the clinical characteristics, management strategies, and outcomes of women enrolled in the Acute Coronary Syndrome Israeli Surveys (ACSIS) between 2000 and 2010. Periods were categorized as early (2000-2004) and late (2006-2010).
  
  
  RESULTS
  Among 11,536 patients enrolled in ACSIS, 2710 (24%) were women. Frequency of women presenting with acute coronary syndrome had declined from 25% in 2000 to 22% in 2010 (P for trend = .002). Women presented less frequently with ST-elevation myocardial infarction and more frequently with associated comorbidities (P < .001 for both). There was no significant reduction in the time delay from symptom onset to emergency department between early and late periods (median: 128 vs 125 minutes; P = .86). This was further reflected in no increase in the frequency of women meeting the goal of door-to-balloon time of ≤90 minutes. The utilization of evidence-based cardiovascular therapies had increased significantly over the past decade (P < .001 for all). After multivariate adjustment, admission in the late surveys was associated with a significant reduction in 30-day major adverse cardiac events and 1-year mortality (hazard ratio 0.76; 95% confidence interval, 0.65-0.9, and 0.73; 0.59-0.89, respectively).
  
  
  CONCLUSIONS
  Despite increased frequency of comorbidities and lack of change in time to admission among women hospitalized with acute coronary syndrome, temporal change in management strategies over the last decade may have contributed to improved outcomes in this population.
authors.affiliation: Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Sabbag
authors.affiliation: Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
authors.affiliation: Department of Cardiology, Shaare-Zedek Medical Center, Bikur Cholim Campus, the Hebrew University School of Medicine, Jerusalem, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Gottlieb
authors.affiliation: Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Paul
authors.initials: P
authors.lastname: Fefer
authors.affiliation: Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Orly
authors.initials: O
authors.lastname: Kohanov
authors.affiliation: Department of Cardiology, The Western Galilee Medical Center, Nahariya, Bar-Ilan University, Ramat-Gan, Israel.
authors.forename: Shaul
authors.initials: S
authors.lastname: Atar
authors.affiliation: Department of Cardiology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Zahger
authors.affiliation: The Heart Institute, Rabin Medical Center, Petach-Tikva, Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Avital
authors.initials: A
authors.lastname: Porter
authors.affiliation: The Heart Center, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Bella
authors.initials: B
authors.lastname: Koifman
authors.affiliation: Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel. Electronic address: amit.segev@sheba.health.gov.il.
authors.forename: Amit
authors.initials: A
authors.lastname: Segev
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D015897:Comorbidity / Q000639:trends; D003325:Coronary Care Units; D003920:Diabetes Mellitus / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007557:Israel / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D010343:Patient Admission; D012042:Registries; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: Acute coronary syndrome; Gender; Outcome; Women