Gender based differences in the presentation, treatment and outcome of Acute Coronary Syndrome patients : insights from the Himachal Pradesh ACS-registry.

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 Gender based differences in the presentation, treatment and outcome of Acute Coronary Syndrome patients : insights from the Himachal Pradesh ACS-registry Mahajan K , Negi PC. Indira Gandhi M C Shimla INTRODUCTION Men (n=1508) Women (n=610) p-value AGE (Years) 59.99+12.67 65.26+12.05 <0.001 RISK FACTORS Diabetes (%) Hypertension (%) Smoking (%) Family history (%) 12.7 26.4 79.85 5.1 18.0 39.9 18.6 4.3 0.2 DIAGNOSIS STEMI (%) NSTEMI/USA (%) 51.7 48.3 36.6 63.4 CLINICAL FEATURES Ignorant of symptoms (%) >6 hrs to FMC (%) Heart rate (beats/min) Systolic BP (mm of Hg) Body mass index (Kg/m2) Killip class>1 (%) 17.7 43.6 80.66+17.49 129.52+27.81 24.26+4.5 20.4 26.3 53.5 83.42+17.67 131.91+28.06 24.05+4.4 27.3 0.07 0.35 IN-HOSPITAL MX Thrombolysis (%) Door-to-needle time, min(median) Aspirin (%) Clopidogrel (%) Statin (%) Beta-blocker (%) ACE/ARB (%) Heparin (%) 38 55 99 99.5 99.4 96.6 94 98.3 35.8 59 97 99.7 99.3 96.4 90.2 98.5 <0.01 0.53 0.36 0.43 0.002 0.30 IN-HOSP. COMPLICATIONS Death (%) LVF (%) CHB (%) Post MI Angina (%) 5.6 22.5 4.0 3.9 8.5 25.6 6.3 3.7 0.009 0.16 0.11 0.09 DISCHARGE TREATMENT Beta Blocker (%) 95.3 96.5 96.2 95 92 91.3 94.5 93.5 92.8 88.6 0.02 0.005 0.03 0.01 RESULTS Women had higher in-hospital mortality. Women continued to receive less OMT at discharge On multivariate analysis gender effect on mortality was attenuated Data from high-income countries suggests that women receive less intensive diagnostic and therapeutic management than men for ACS. There is paucity of such data in Indian population, which is 69% rural. Prior studies have focussed mainly on urban populations. Outcome Unadjusted logistic regression model Logistic regression model adjusted for age Multivariate logistic regression model In hospital death [OR(95%CI)] 1.57 (1.10-2.26) 1.30 (0.90-1.87) 1.36 (0.77-2.38) METHODS 1 year data (July 2015-June 2016) was recorded from 33 hospitals across Himachal Pradesh covering more than 90% of state population. Baseline characteristics, medical history, treatments and in-hospital mortality rates of 2118 ACS patients were assessed. Differences between genders were assessed via t test and χ2 test. DISCUSSION The baseline characteristics were similar to those observed in the DEMAT registry Ignorance of symptoms, delayed presentation, less optimized treatments/reperfusion strategies and higher mortality-rates were observed among women. These results differ significantly from the results of Kerela ACS registry. RESULTS CONCLUSIONS Women constituted less than one-third of ACS population. Women with ACS were older than men with ACS and were more likely to present with USA/NSTEMI . Ignorance of symptoms and late presentation were more common in females who more frequently had Killip class>1. Lesser women received optimal guideline based treatment and PCI(0.9% vs 4.2%,p-value<0.01). These are among the first population representative data from India, comprising predominantly of rural population, to evaluate sex differences in ACS. It demonstrates a significant gender based difference between symptom awareness, delay in presentation, management and outcome . Furthur studies are warranted across other parts of India to investigate this gender bias.