Abstract 76: Are There Gender Differences on Admission Time, Disease Severity and Treatment at Emergency Room for Acute Coronary Syndrome?
Controversies exist in relation to admission hours at emergency room (ER) and treatment used in women and men with acute coronary syndromes (ACS). Women supposed to be treated inadequately or later to explain higher mortality after acute myocardial infarction (AMI). Methods: from January 2003, we prospectively analyzed admission time, clinical characteristics, laboratory, angiographic findings and hospital mortality in 579 patients with ACS in a tertiary hospital ER setting. Admission hours were categorized in four daily periods each one of 6 hours. Traditional risk factors were analyzed; severity of atherosclerosis was based in the number of coronary involved with greater than 50% reduction in lumen size at angiography; and treatment used was classified in clinical, angioplasty plus stent placement and surgical myocardial revascularization. Results: age (59.8±11.8 vs 63.2±11.9 years; p<0.01), smoking (16% vs 6%; p=0.026), hypertension (47% vs 31%; p=0.032), diabetes (16% vs 13%; p=0.013) and dyslipidemia (24% vs 18%; p=0.030) were greater in men. Admission times were similar in women and men for all daily periods [0:01h–6:00h: 16% vs 13%; 6:01h–12:00h: 30% vs 30%; 12:01h–18:00h: 32% vs 28%; 18:01–24:00h: 25% vs 26%; (p=NS)]. Severity of coronary disease was greater in men and underwent to more angioplasty with stent placement (39% vs 17%; p<.01). Clinical (20% vs 18%; p=NS) and CABG (4% vs 2%; p=NS) treatments showed no gender differences. Multivariate analysis disclosed body mass index [OR=0.91 (IC95%:0.85– 0.98); p=0.01], monocytosis [OR=0.83 (IC95%:0.75– 0.92); p<0.01] and CK mass peak [OR=0.99 (IC95%: 0.99 –1.00); p=0.02] as independent variables associated with ACS in men. Nevertheless, hospital mortality (3% vs 2%) was similar for all admission times in both women and men. In conclusion, there were no gender differences in arrival time at ER and severity of coronary disease was greater in men justifying more percutaneous intervention in them.