SPC365

Gender Disparities in Acute Coronary Syndromes: A Comprehensive Analysis of Management, Treatment, and Prognosis

Session: Comunicações Orais - Sessão 15 - Síndrome coronária aguda 2
Speaker: António Maria Rocha de Almeida

Congress: CPC 2024
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.7 Acute Coronary Syndromes - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: António Maria Rocha De Almeida; Miguel Carias de Sousa; Marta Paralta Figueiredo; Rafael Viana; Kisa Congo; David Neves; Renato Fernandes; Manuel Trinca; Lino Patrício

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Sex disparity in access to healthcare and management of cardiovascular disease (CVD) is still significant, leading to suboptimal treatment of acute coronary syndromes (ACS). This study aims to evaluate differences in accessibility, management and its prognosis&nbsp;between women and men with ACS.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Multicenter retrospective cohort of 6000 patients with ACS was divided according to patient&rsquo;s sex. CV risk factors, time to first medical care (FMC), to ECG,&nbsp;coronary angiography&nbsp;(CAG) and percutaneous coronary intervention (PCI) were evaluated. The outcomes assessed were major adverse cardiac events (MACE), in hospital and follow-up death, reference to cardiac rehabilitation and hospital readmission.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">From the 6000 patients, 30% (n=1784) were female, with mean age of 73&plusmn;13 years. 70% (n=4216) of the patients were male, with mean age of 65&plusmn;13years. Women were significantly older (p&lt;0,001). Despite the significantly higher prevalence of CV risk factors in women, namely hypertension (81% vs 69%, p&lt;0,001), diabetes (38% vs 31%, p&lt;0,001) and dyslipidemia (60% vs 57%, p=0,02), the time to FMC is statistically significantly longer in women (10,6 hours vs 9,5 hours, p&lt;0,001), and the median time to ECG was similar (101 min vs 110 min, p=0,9). Non-ST segment elevation ACS (NSTE-ACS) was higher in women (65% vs 61% p&lt;0,001 OR 1,2 [1,1-1,4])</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Female patients were significantly less likely to undergo CAG, (68% vs 79% p&lt;0,001 OR 0,6 [0,5-0,7]), and to be done less PCI than men (82% vs 86% p&lt;0,001 OR 0,7 [0,6-0,8]). Still, there were no statistically significant differences in terms of unfavorable anatomy (63% vs 66%, p=0,5), and women had less multivessel disease (12% vs 18% p&lt;0,001). Successful PCI was similar among groups (95% p=0,9).</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">About outcomes, women&rsquo;s in-hospital death and MACE were higher than men&rsquo;s (12% vs 7% p&lt;0,001 HR 1,8 [1,5-2,2] and 7% vs 5% p=0,005, HR 1,5 [1,1-2]). Women had more heart failure (28% vs 19%, p&lt;0,01 HR 1,7 [1,5-1,9]), cardiogenic shock (8% vs 5%, p&lt;0,001 HR 1,6 [1,3-2]), and mechanical complications (2% vs 1% p&lt;0,01 HR 2,5 [1,6-3,8]). There were no differences in myocardial infarction (1% vs 1%, p=0,6). Women were less likely to be referenced to cardiac rehabilitation (33% vs 38% p&lt;0,001 OR 0,8 [0,7-0,9]).</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Mean follow-up was 16&plusmn;7 months. Women had a statistically higher mortality during follow-up (15% vs 11% p&lt;0,001 HR 1,5 [1,2-1,7]). The median survival time was statistically inferior in women (48 months vs 54 months p&lt;0,001). Also&nbsp;women had significantly more hospital readmissions (28% vs 24% p=0,004 OR 1,2 [1,1-1,4]). The median time of hospital admission was statistically inferior in women (39 months vs 46 months p&lt;0,001).</span></span></p>

<p style="text-align:justify"><strong>Conclusion</strong></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Despite the awareness, CVD in women remains underestimated. Women take longer to seek medical care and are less likely to undergo to CAG and PCI. This ends in worse early and long-term prognosis, with higher mortality and MACE on follow-up. </span></span></p>