title: Sex Differences in the Presentation, Diagnosis, and Management of Acute Coronary Syndromes: Findings From the Kerala-India ACS Registry.
abstract: BACKGROUND
  Previous literature from high-income countries has repeatedly shown sex differences in the presentation, diagnosis, and management of acute coronary syndromes (ACS), with women having atypical presentations and undergoing less aggressive diagnostic and therapeutic measures. However, much less data exist evaluating sex differences in ACS in India.
  
  
  OBJECTIVE
  This study sought to evaluate sex differences in the diagnosis, management, and treatment of patients with ACS in Kerala, India.
  
  
  METHODS
  The Kerala ACS Registry collected data from 25,748 consecutive ACS admissions (19,923 men and 5,825 women) from 125 hospitals in the Indian state of Kerala from 2007 to 2009. This study evaluated the association between sex differences in presentation, in-hospital management, and discharge care with in-hospital mortality and in-hospital major adverse cardiovascular events (defined as death, reinfarction, stroke, heart failure, or cardiogenic shock).
  
  
  RESULTS
  Women with ACS were older than men with ACS (64 vs. 59, p < 0.001) and were more likely to have a history of previous myocardial infarction (16% vs. 14%, p < 0.001). Inpatient diagnostics and management and discharge care were similar between sexes. No significant differences between men and women in the outcome of death (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 0.80 to 1.38) or in the composite outcome of death, reinfarction, stroke, heart failure, or cardiogenic shock (OR: 0.99, 95% CI: 0.79 to 1.25) were seen after adjustment for possible confounding factors.
  
  
  CONCLUSIONS
  In Kerala, even though women with ACS were older and more likely to have previous myocardial infarction, there were no significant differences in in-hospital and discharge management, in-hospital mortality, or major adverse cardiovascular events between sexes. Whether these results apply to other parts of India or acute presentations of other chronic diseases in low- and middle-income countries warrants further study.
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: amisha.patel@northwestern.edu.
authors.forename: Amisha
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Cardiology, Government Tirumala Devaswom Medical College, Vandanam, Alappuzha, India.
authors.forename: Sunitha
authors.initials: S
authors.lastname: Vishwanathan
authors.affiliation: Department of Cardiology, PRS Hospital, Killipalam, Thiruvananthapuram, India.
authors.forename: Tiny
authors.initials: T
authors.lastname: Nair
authors.affiliation: Department of Cardiology, Anathapurai Hospital, NH Bypass, Chacka, Thiruvananthapuram, India.
authors.forename: C G
authors.initials: CG
authors.lastname: Bahuleyan
authors.affiliation: Department of Cardiology, Government Medical College, Gandhinagar, Kottayam, India.
authors.forename: V L
authors.initials: VL
authors.lastname: Jayaprakash
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Abigail
authors.initials: A
authors.lastname: Baldridge
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Huffman
authors.affiliation: Centre for Chronic Disease Control-New Delhi, India, Gurgaon, India.
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
authors.affiliation: Department of Cardiology, Westfort Hi-Tech Hospital-Thrissur, India, Punkunnam, Thrissur, India.
authors.forename: P P
authors.initials: PP
authors.lastname: Mohanan
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D000787:Angina Pectoris / Q000209:etiology; D002317:Cardiovascular Agents / Q000627:therapeutic use; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012042:Registries; D017678:Sex Distribution
chemical_list: D002317:Cardiovascular Agents