title: Gender difference in the use of coronary interventions for patients with acute coronary syndrome: Experience from a major metropolitan hospital in Melbourne, Australia.
abstract: BACKGROUND
  Literature suggests an ongoing gender disparity in the use of coronary angiography and subsequent interventions among patients with acute coronary syndrome (ACS).
  
  
  OBJECTIVE
  The study aimed to examine gender differences in the use of coronary interventions amongst patients with acute coronary syndrome (ACS) admitted to a major metropolitan hospital in Melbourne during the period 2009-2012.
  
  
  METHODS
  We undertook a retrospective analysis of a hospital database of 2096 ACS patients. ACS included unstable angina (UA), ST-segment-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI).
  
  
  RESULTS
  The mean age of the patients was 64.3 years and 624 (30%) were women. Half of them were diagnosed as NSTEMI, 23% as STEMI and 25% as UA. Compared to men, women were older at admission, less likely to be diagnosed with STEMI and less likely to smoke. No gender difference was observed for severe co-morbidities or use of coronary angiography. Women diagnosed with STEMI were 39% less likely to receive an angioplasty stent (adjusted odds ratio 0.61, 95% confidence intervals 0.39-0.96) and 66% less likely to receive grafts (adjusted OR 0.34, 95% CIs 0.13-0.93). Women diagnosed with NSTEMI were 44% less likely to receive grafts (adjusted OR 0.56, 95% CIs 0.37-0.83). Younger women aged 35-49 years were less likely to receive an angioplasty stent, and older women >50 years were less likely to receive grafts.
  
  
  CONCLUSIONS
  Adherence to guideline based treatment will help to ensure knowledge translation from guideline to practice. Further research investigating symptom presentation, use of non-invasive tests and medical management of ACS by gender may further explain gender difference for coronary interventions.
authors.affiliation: Her Heart Ltd., Melbourne, Australia; The Cardiovascular Research Centre (CvRC) and St Vincent's Centre for Nursing Research (SVCNR), Australian Catholic University, Melbourne, Australia; St Vincent's Hospital Melbourne, Australia. Electronic address: lindaworrallcarter@herheart.org.au.
authors.forename: Linda
authors.initials: L
authors.lastname: Worrall-Carter
authors.affiliation: St Vincent's Hospital Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: MacIsaac
authors.affiliation: Kaiser Permanente (NCAL) Regional Quality and Regulatory Services, CA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Scruth
authors.affiliation: The Cardiovascular Research Centre (CvRC) and St Vincent's Centre for Nursing Research (SVCNR), Australian Catholic University, Melbourne, Australia; National Centre for Farmer Health, Deakin University, Geelong, Australia.
authors.forename: Muhammad Aziz
authors.initials: MA
authors.lastname: Rahman
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000628:therapy*; D000328:Adult; D015897:Comorbidity; D017023:Coronary Angiography; D005260:Female; D019983:Guideline Adherence; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D014739:Victoria
keywords: Acute coronary syndrome; Angiography; Angioplasty; Australia; Coronary intervention; Gender; Grafts