title: Impact of gender on use of revascularization in acute coronary syndromes: the national observational study of diagnostic and interventional cardiac catheterization (ONACI).
abstract: OBJECTIVE
  To assess the impact of gender on myocardial revascularization using data collected in a French nationwide registry: the national observational study of diagnostic and interventional cardiac catheterization (ONACI).
  
  
  BACKGROUND
  Gender differences in management of patients with acute coronary syndromes (ACS) have been reported.
  
  
  METHODS
  We analysed data from a nationwide French prospective multicentre registry including 64,932 suspected ACS patients recruited in 99 centres from 2004 to 2008.
  
  
  RESULTS
  Overall, women were older (70.7 ± 12.7 vs. 63.8 ± 12.9 years), had a higher cardiovascular risk profile, and were more frequently admitted with non ST-elevation myocardial infarction or unstable angina (NSTEMI/UA) compared to men (73% vs. 68%). Women had significantly more angiographically normal coronary arteries or non-significant coronary artery disease (CAD) in both STEMI (6% vs. 3%) and NSTEMI/UA (21% vs. 11%) while men had more severe CAD. After adjusting for age, cardiovascular risk factors, and extent of disease, myocardial revascularization (defined as the use of percutaneous coronary intervention (PCI) or coronary artery bypass grafting) was less frequently used in women (adjusted OR = 0.78; 95% CI: 0.77-0.83). For those receiving PCI, in-hospital mortality within 24 hr of intervention was higher in women (3.6% vs. 1.2%; adjusted OR = 1.51; 95% CI: 1.22-1.87).
  
  
  CONCLUSIONS
  In the present study, despite having a higher cardiovascular risk profile, women more frequently had normal vessel/non-significant angiographic coronary artery disease. In patients with significant coronary artery disease, myocardial revascularization was less frequently used in women whatever the type of ACS.
authors: Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes, Paris, France.
authors: Marc-Antoine
authors: MA
authors: Isorni
authors: Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes, Paris, France.
authors: Didier
authors: D
authors: Blanchard
authors: Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes, Paris, France.
authors: Nelson
authors: N
authors: Teixeira
authors: Department of Cardiology, University Hospital of Rennes, Rennes, France.
authors: Hervé
authors: H
authors: le Breton
authors: Paris Cardiovascular Research Center PARCC, INSERM U970, Paris, France.
authors: Nisa
authors: N
authors: Renault
authors: Department of Cardiology, University Hospital of Brest, Brest, France.
authors: Martine
authors: M
authors: Gilard
authors: Department of Cardiology, Institut Hospitalier Jacques Cartier, Massy, France.
authors: Thierry
authors: T
authors: Lefèvre
authors: Société Française De Cardiologie, Paris, France.
authors: Geneviève
authors: G
authors: Mulak
authors: Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes, Paris, France.
authors: Nicolas
authors: N
authors: Danchin
authors: Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes, Paris, France.|Paris Cardiovascular Research Center PARCC, INSERM U970, Paris, France.
authors: Christian
authors: C
authors: Spaulding
authors: Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Des Hôpitaux De Paris, France; Université Paris Descartes, Paris, France.|Paris Cardiovascular Research Center PARCC, INSERM U970, Paris, France.
authors: Etienne
authors: E
authors: Puymirat
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D054624:Health Status Disparities; D054625:Healthcare Disparities; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D017064:Process Assessment, Health Care / Q000706:statistics & numerical data*; D057216:Propensity Score; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome
keywords: Keys words: acute coronary syndrome; gender; myocardial revascularization; percutaneous coronary intervention