title: Differences in the treatment and evolution of acute coronary syndromes according to gender: what are the causes?
abstract: OBJECTIVE
  The objectives of this study were to analyse the differences in the treatment and the evolution of acute coronary syndromes according to the gender of the patient and to determine the likely causes of these differences.
  
  
  BACKGROUND
  Epidemiological studies confirm the differences in the course and treatment of acute coronary syndromes according to factors such as gender and age. The factors associated with the observed gender-based differences are not known.
  
  
  METHODS
  This prospective study was conducted on 596 patients treated in the Hospital Emergency Service of the Hospital Complex of Navarra, Spain, from 1 January 2012 to April 2013 with acute coronary syndromes. A bivariate and logistic analysis has been made by adjusting the age and severity of process to know the differences by gender.
  
  
  RESULTS
  A total of 71·8% (n = 428) were men, and the remaining 28·2% (168) were women. The mean age of the men was 66·4 ± 12·7 years, and the mean age of the women was 72·5 ± 13·9 years. We found that antiplatelet drugs (68·4 vs. 22·7%), blockers (70 vs. 25·4%), ACE inhibitors (56·2 vs. 15·6%), fibrinolysis (17·2 vs. 4·5%, p = 0·025) and primary angioplasty (AP) (38·7 vs. 16·3%, p = 0·008) were less frequently administered to women compared with men. We observed an additional delay in the demand for health care in women with acute coronary syndromes compared with men.
  
  
  CONCLUSIONS
  There is an association between treatment differences and gender. The delay in the request of health care in women is observed to be the largest correlating factor, in addition to voluntary discharge in women affected by acute coronary syndromes.
  
  
  CONCLUSIONS
  Delays in seeking medical care or voluntary discharge are likely factors related to worse outcomes in women. These factors should be explored, and the results should be made available to the public, particularly to women.
authors: Emergency Service, Hospital Complex of Navarre, Navarre, Spain.
authors: Marta
authors: M
authors: Ferraz-Torres
authors: Emergency Service, Hospital Complex of Navarre, Navarre, Spain.|Department of Health Sciences of the Public University of Navarre, Navarre, Spain.
authors: Tomás
authors: T
authors: Belzunegui-Otano
authors: Department of Nursing, Department of Health Sciences, Public University of Navarre, Navarre, Spain.
authors: Blanca
authors: B
authors: Marín-Fernandez
authors: Anaesthesia, Critical Care and Pain Medicine Service, Ubarmin Clinic, Navarre, Spain.
authors: Óscar
authors: Ó
authors: Martinez-Garcia
authors: Navarrobioned, Methodology Unit NavarraBiomed Miguel Servet Foundation, Navarre, Spain.
authors: Berta
authors: B
authors: Ibañez-Beroiz
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000451:nursing / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003695:Delivery of Health Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology
keywords: acute coronary syndromes; causes; gender; treatment