title: Gender Differences in Presentation, Coronary Intervention, and Outcomes of 28,985 Acute Coronary Syndrome Patients in Victoria, Australia.
abstract: BACKGROUND
  Differences in demographics, presenting characteristics, and treatment of heart disease in women may contribute to adverse outcomes. The purpose of this paper was to describe gender differences in the epidemiology, treatment, and outcomes of all admissions for acute coronary syndrome (ACS) in Victoria that occurred between June 2007 and July 2009.
  
  
  METHODS
  We undertook a retrospective cohort study of all patients admitted to Victorian hospitals with a first time diagnosis of ACS. Use of angiograms, percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and adverse outcomes (death and/or unplanned readmission) were compared by gender and hierarchical logistic regression models were used to account for confounding variables.
  
  
  RESULTS
  Of a total of 28,985 ACS patients, 10,455 (36%) were women. Compared with men, women were older (aged ≥75 years: 54% vs 31%; p < .001), more likely to present with multiple comorbidities (>1 comorbidity: 53% vs 46%; p < .001), and more likely to be diagnosed with non-ST-segment elevation ACS (86% vs 80%; p < .001). Women were less likely to receive coronary interventions (angiogram: adjusted odds ratio [aOR], 0.71; 95% CI, 0.66-0.75; PCI: aOR, 0.73; 95% CI, 0.66-0.80; CABG: aOR, 0.58; 95% CI, 0.53-0.64). Adverse outcomes were similar in women and men after accounting for confounding variables.
  
  
  CONCLUSIONS
  Our results show that women in Victoria were less likely to receive coronary interventions after an admission for ACS. Clinicians should be wary of inherent gender bias in decisions to refer patients for angiography.
authors.affiliation: Her Heart Ltd, Melbourne, Australia; 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. Electronic address: lindaworrallcarter@herheart.org.au.
authors.forename: Linda
authors.initials: L
authors.lastname: Worrall-Carter
authors.affiliation: St Vincent's Centre for Nursing Research (SVCNR), Australian Catholic University, Melbourne, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: McEvedy
authors.affiliation: St Vincent's Hospital, Melbourne, Australia; The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, Australia; The University of Melbourne, Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
authors.affiliation: 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 (MMIHR), Australian Catholic University, Melbourne, Australia.
authors.forename: Muhammad Aziz
authors.initials: MA
authors.lastname: Rahman
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001026:Coronary Artery Bypass; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology