Abstract 1588: Worldwide Gender Bias in Angiographic Obstructive Acute Coronary Syndromes?
Background. Evaluating the number of medical or interventional treatments of a registry cohort allows the inclusion of women without obstructive CAD, potentially confounding the results toward an apparent sex bias against women.
Aim. The aim of this study was to ascertain whether effective evidence based treatments for acute coronary syndromes (ACS) are underutilized among women with documented coronary disease in various geographic areas compared with men.
Methods. We collected data from 3 registries: the Finnish TACOS (Tampere Acute COronary Syndrome), the British EMMACE 2 (Evaluation of Methods and Management of Acute Coronary Events), and the Argentine PACS-ITALSIA (Prognosis in Acute Coronary Syndromes and the ITALian hospital Sindrome Isquemico Agudo). The gold standard test to which effective discharge treatments were compared was required to be angiographic evidence of obstructive coronary disease (more than 50% lumen diameter stenosis).
Results. The Finnish TACOS, the British EMMACE 2, and the Argentine PACS-ITALSIA enrolled 419, 1252, and 945 patients with ACS and at least 1 obstructive coronary lesion, respectively. We found substantial geographic variations. In Finland, there were no significant differences between men and women regarding discharge medications. Conversely, in the United Kingdom (UK) and Argentina men received more evidence-based therapy than did women. Women were remarkably less likely to receive aspirin (UK OR 0.50; CI 0.41 to 0.60; p<0.01 Argentina OR 0.50; CI 0.41 to 0.60; p<0.01), beta-blockers (UK OR 0.39; CI 0.33 to 0.47; p<0.01 Argentina OR 0.39; CI 0.33 to 0.47; p<0.01) and statins (UK OR 0.65; CI 0.54 to 0.77; p<0.01 Argentina OR 0.39; CI 0.33 to 0.47; p<0.01) at discharge. In UK, coronary revascularization tended to be done less frequently in women (OR 0.39; CI 0.33 to 0.47; p<0.01).
Conclusions. Our study indicates the existence of large gender differences in ACS treatment even in patients with documented significant coronary disease. Substantial geographic variation exists. There is an urgent need to analyze disparities across population subgroups and between different countries.