1.  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)
<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
20.4
26.3
53.5
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
( )
1.30
( )
1.36
( )
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 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.