Impact of comorbidities and gender on the use of coronary interventions in patients with high-risk non-ST-segment elevation acute coronary syndrome.
OBJECTIVE
To determine the impact of gender and comorbidity on use of coronary interventions in patients diagnosed with high-risk non-ST-segment acute coronary syndrome (NSTEACS).


BACKGROUND
Guidelines recommend the use of coronary angiography for all patients diagnosed with NSTEACS with high-risk features, except in the presence of severe comorbidities. However, little is understood about the relationship between gender, comorbidity, and the use of coronary interventions.


METHODS
Retrospective analyses of the Victorian Admitted Episodes Data Set (VAED) including all patients diagnosed with NSTEACS with high-risk features on their first admission for ACS between June 2007 and July 2009. Hierarchical logistic regression models and correspondence analyses were used to understand the relationship between gender, comorbidities, and the use of coronary interventions.


RESULTS
Out of 16,771 NSTEACS patients with high-risk features, 6,338 (38%) were female. Females were older than males (aged ≥75: 62% vs 39%, p < 0.001) and more likely to have multiple comorbidities (≥2: 66% vs 59%, p < 0.001). After adjusting for potential confounders, females were more likely to receive no coronary intervention than males with a similar number of comorbid conditions (no comorbidities: OR 1.62, 95% CI 1.28-2.05; 1 comorbidity: OR 1.67, 95% CI 1.44-1.93; 2 comorbidities: OR 1.93, 95% CI 1.66-2.23; ≥3 comorbidities: OR 1.42, 95% CI 1.27-1.60).


CONCLUSIONS
Lower rates of coronary intervention in females persisted after adjusting for number of comorbidities which suggests that gender may bias decisions regarding referral for coronary intervention in high-risk NSTEACS independent of other factors.
St Vincent's Centre for Nursing Research (SVCNR), Australian Catholic University, Melbourne, Australia.|St Vincent's Hospital, Melbourne, Australia.|The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, Australia.
Linda
L
Worrall-Carter
St Vincent's Centre for Nursing Research (SVCNR), Australian Catholic University, Melbourne, Australia.
Samantha
S
McEvedy
St Vincent's Hospital, Melbourne, Australia.|The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, Australia.|The University of Melbourne, Melbourne, Australia.|Department of Health, VicHealth, Victorian Cardiology Clinical Network, Melbourne, Australia.
Andrew
A
Wilson
St Vincent's Centre for Nursing Research (SVCNR), Australian Catholic University, Melbourne, Australia.|The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, Australia.|Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
Muhammad Aziz
MA
Rahman
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D017023:Coronary Angiography; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
angiogram; coronary heart disease; correspondence analysis; percutaneous coronary intervention; women