Abstract 13324: Sex Differences in Presentation, Management, and Outcomes of Acute Coronary Syndrome in India: Results from the Detection and Management of Coronary Heart Disease (DEMAT) Registry
Introduction: Prior research in high-income countries suggests that women with acute coronary syndromes (ACS) are managed less aggressively than men, even after adjustment for age and co-morbidities, with subsequent worse short-term clinical outcomes. Few such analyses have been performed in India. HYPOTHESIS We assessed the hypothesis that women receive less aggressive in-hospital and discharge guideline-based care for ACS in India, which leads to worse in-hospital and short-term clinical outcomes.
Methods: We studied 1,448 consecutive patients with suspected ACS (23% women; mean age 58.2 ± 11.4 years) from 9 hospitals in India between 2007-8. Medical history, diagnostics, treatments, and in-hospital, 30-day and 6-month mortality rates were assessed. Differences between sexes were assessed via t test and χ2 test.
Results: Baseline demographics, medical history, and medical therapy were similar between women and men (Table 1). Women were more likely to present with unstable angina (USA) (44.2% vs. 30.0%, p<0.001) and less likely to present with ST-elevation myocardial infarction (STEMI) (34.8% vs. 51.8%, p=<0.001). Baseline medical therapy, including thrombolysis in the setting of STEMI, and revascularization were similar between sexes. Women were less likely to receive clopidogrel prescription at discharge (86.6% vs. 91.1%, p=0.03). Other guideline-based discharge prescription rates were similar. In-hospital (2.1% vs. 1.9%, p=0.79), 30-day (3.4% vs. 2.6%, p=0.38), and 6-month (3.9% vs. 3.0%, p=0.37) mortality rates were similar.
Conclusion: These are among the first data from India to evaluate sex differences in ACS presentation and management. In 9 hospitals in India, women were more likely to present with USA and less likely to present with STEMI. Overall, guideline-based therapy was high, and women received similar in-hospital and discharge ACS management to men. Subsequent in-hospital, 30-day, and 6-month mortality rates were similar.
- © 2010 by American Heart Association, Inc.