title: Developments in the invasive diagnostic-therapeutic cascade of women and men with acute coronary syndromes from 2005 to 2011: a nationwide cohort study.
abstract: OBJECTIVE
  To investigate for trends in sex-related differences in the invasive diagnostic-therapeutic cascade in a population of patients with acute coronary syndromes (ACS).
  
  
  METHODS
  A nationwide cohort study.
  
  
  METHODS
  Administrative and clinical registries covering all hospitalisations, invasive cardiac procedures and deaths in the Danish population of 5.6 million inhabitants.
  
  
  METHODS
  We included 52,565 patients aged 30-90 years who were hospitalised with a first ACS from January 2005 to November 2011. Follow-up was 60 days from the day of index admission.
  
  
  METHODS
  Diagnostic coronary angiography, percutaneous coronary intervention or coronary artery bypass within 60 days of index admission.
  
  
  RESULTS
  Women constituted 36%, were older, had more comorbidity and were less likely to be admitted to a hospital with cardiac catheterisation facilities than men. Mortality rates were similar for both sexes. Diagnostic coronary angiography was performed less frequently on women compared with men, both within 1 day (31% vs 42%; p<0.001) and within 60 days (67% vs 80%; p<0.001), yielding adjusted female-male HRs of 0.83 (0.79-0.87) and 0.86 (0.84-0.89), respectively.Among the 39,677 patients undergoing coronary angiography, non-obstructive coronary artery disease was more frequent among women than men (22% vs 9%; p<0.001). Women were less likely to undergo percutaneous coronary intervention (58% vs 72%; p<0.001) and coronary artery bypass (6% vs 11%, p<0.001) within 60 days than men, yielding adjusted HRs of 0.96 (0.92-0.99) and 0.81 (0.74-0.89), respectively. The sex-related differences were not attenuated over time for any of the invasive cardiac procedures (p values for trend >0.05).
  
  
  CONCLUSIONS
  In this nationwide study, men were more likely to undergo an invasive approach than women when hospitalised with a first ACS--a difference persisting from 2005 to 2011. Future studies should focus on the potential mechanisms behind this differential treatment.
authors.affiliation: Department of Cardiology, University Hospital Bispebjerg, Bispebjerg, Denmark.
authors.forename: Kim Wadt
authors.initials: KW
authors.lastname: Hansen
authors.affiliation: Department of Cardiology, University Hospital Gentofte, Hellerup, Denmark.
authors.forename: R
authors.initials: R
authors.lastname: Soerensen
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Madsen
authors.affiliation: Emergency Department, Holbaek University Hospital, Holbaek, Denmark.
authors.forename: J K
authors.initials: JK
authors.lastname: Madsen
authors.affiliation: Department of Cardiology, University Hospital Gentofte, Hellerup, Denmark Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: J S
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark The Danish Heart Registry, Denmark.
authors.forename: L M
authors.initials: LM
authors.lastname: von Kappelgaard
authors.affiliation: The Danish Heart Registry, Denmark Department of Thoracic Surgery, Odense University Hospital, Denmark.
authors.forename: P E
authors.initials: PE
authors.lastname: Mortensen
authors.affiliation: Department of Cardiology, University Hospital Bispebjerg, Bispebjerg, Denmark The Danish Heart Registry, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Galatius
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D015897:Comorbidity; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D012042:Registries; D012737:Sex Factors