Gender based differences in clinical and Angiographic characteristics and outcomes of Acute Coronary Syndrome (ACS) in Asian population

Altaf, Afrasyab; Shah, Hammad; Salahuddin, Momin

doi:10.12669/pjms.35.5.743

Cited by 8 publications

(8 citation statements)

References 20 publications

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“…Pakistan, a country generally grouped within South Asia, shares the South Asian CVD characteristics of the Indian subcontinent [ 103 ] but is categorized within the EMR by the WHO. Demographics were similar to EMR and South Asian registries [ 99 ], but women had longer pre-hospital delays in seeking treatment, attributing these delays to social factors, such as worry about expenses and bystanders’ responses to their symptoms. This differed from men, whose delays were attributed to not recognizing the symptoms as cardiac [ 104 ].…”

Section: Eastern Mediterranean Region (Emr)mentioning

confidence: 79%

“…The EMR includes countries of the Arabian Gulf, Middle East and Northern Africa (MENA), and Western Asia. Large ACS registries and sex-specific analyses exist in the region, particularly from Saudi Arabia [ 18 , 20 ], the United Arab Emirates (UAE) [ 17 , 96 , 97 ], Egypt [ 98 ] and Pakistan [ 99 ].…”

Section: Eastern Mediterranean Region (Emr)mentioning

confidence: 99%

“…This reflects an underlying cultural aspect that might influence treatment-seeking behavior, where women are often curtailed in decision making and access to healthcare, owing to dependence on both finances and mobility [ 104 ]. Women were less aggressively treated with coronary interventions and had more adverse events as compared to males [ 99 ], although impaired renal dynamics were more frequently seen among men, similar to a large Bangladeshi ACS cohort [ 105 ].…”

Section: Eastern Mediterranean Region (Emr)mentioning

confidence: 99%

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Sex Differences in Acute Coronary Syndromes: A Global Perspective

Cader

Banerjee

Gulati

2022

JCDD

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Despite increasing evidence and improvements in the care of acute coronary syndromes (ACS), sex disparities in presentation, comorbidities, access to care and invasive therapies remain, even in the most developed countries. Much of the currently available data are derived from more developed regions of the world, particularly Europe and the Americas. In contrast, in more resource-constrained settings, especially in Sub-Saharan Africa and some parts of Asia, more data are needed to identify the prevalence of sex disparities in ACS, as well as factors responsible for these disparities, particularly cultural, socioeconomic, educational and psychosocial. This review summarizes the available evidence of sex differences in ACS, including risk factors, pathophysiology and biases in care from a global perspective, with a focus on each of the six different World Health Organization (WHO) regions of the world. Regional trends and disparities, gaps in evidence and solutions to mitigate these disparities are also discussed.

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Section: Eastern Mediterranean Region (Emr)mentioning

confidence: 79%

Section: Eastern Mediterranean Region (Emr)mentioning

confidence: 99%

Section: Eastern Mediterranean Region (Emr)mentioning

confidence: 99%

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Sex Differences in Acute Coronary Syndromes: A Global Perspective

Cader

Banerjee

Gulati

2022

JCDD

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“…However, female patients were significantly less likely to undergo elective diagnostic coronary angiography and angioplasty during the pandemic (Table 2 ). Women in our part of the world face many challenges in accessing timely healthcare due to cultural barriers, reliance on males in the family for transport, lack of education, and prioritizing the health of male family members over their own, just to name a few [ 17 18 19 ]. Understandably, all these factors are amplified during the pandemic and lockdowns.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on Cardiovascular Disease Presentation, Emergency Department Triage and Inpatient Cardiology Services in a Low- to Middle-Income Country – Perspective from a Tertiary Care Hospital of Pakistan

et al. 2021

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Aims: To identify the changes in cardiovascular disease presentation, emergency room triage and inpatient diagnostic and therapeutic pathways. Methods: We conducted a retrospective cohort study at the Aga Khan University Hospital, Karachi. We collected data for patients presenting to the emergency department with cardiovascular symptoms between March–July 2019 (pre-COVID period) and March–July 2020 (COVID period). The comparison was made to quantify the differences in demographics, clinical characteristics, admission, diagnostic and therapeutic procedures, and in-hospital mortality between the two periods. Results: Of 2976 patients presenting with cardiac complaints to the emergency department (ED), 2041(69%) patients presented during the pre-COVID period, and 935 (31%) patients presented during the COVID period. There was significant reduction in acute coronary syndrome (ACS) (8% [95% CI 4–11], p < 0.001) and heart failure (↓6% [95% CI 3–8], p < 0.001). A striking surge was noted in Type II Myocardial injury (↑18% [95% CI 20–15], p < 0.001) during the pandemic. There was reduction in cardiovascular admissions (coronary care unit p < 0.01, coronary step-down unit p = 0.03), cardiovascular imaging (p < 0.001), and procedures (percutaneous coronary intervention p = 0.04 and coronary angiography p = 0.02). No significant difference was noted in mortality (4.7% vs. 3.7%). The percentage of patients presenting from rural areas declined significantly during the COVID period (18% vs. 14%, p = 0.01). In the subgroup analysis of sex, we noticed a falling trend of intervention performed in females during the COVID period (8.2% male vs. 3.3 % female). Conclusions: This study shows a significant decline in patients presenting with Type I myocardial infarction (MI) and a decrease in cardiovascular imaging and procedures during the COVID period. There was a significant increase noted in Type II MI.

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“…Due to differences in the prevalence of ACS [ 7 , 15 ] and in the degree of increase in cardiac troponin levels in men and women at the early stages of diagnostics, several authors propose a gender-based approach to the early diagnostics of ACS [ 16 ]. A gender-oriented approach to early diagnosis of ACS implies the use of different threshold levels (99th percentile) and kinetics in increased cardiac troponins in men and women [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Gender Specificities of Cardiac Troponin Serum Levels: From Formation Mechanisms to the Diagnostic Role in Case of Acute Coronary Syndrome

Chaulin

2023

Life

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Cardiac troponins T and I are the main (most sensitive and specific) laboratory indicators of myocardial cell damage. A combination of laboratory signs of myocardial cell damage (elevated levels of cardiac troponins T and I) with clinical (severe chest pain spreading to the left side of the human body) and functional (rise or depression of the ST segment, negative T wave or emergence of the Q wave according to electrocardiography and/or decrease in the contractility of myocardial areas exposed to ischemia according to echocardiography) signs of myocardial ischemia is indicative of the ischemic damage to cardiomyocytes, which is characteristic of the development of acute coronary syndrome (ACS). Today, with early diagnostic algorithms for ACS, doctors rely on the threshold levels of cardiac troponins (99th percentile) and on the dynamic changes in the serum levels over several hours (one, two, or three) from the moment of admission to the emergency department. That said, some recently approved highly sensitive methods for determining troponins T and I show variations in 99th percentile reference levels, depending on gender. To date, there are conflicting data on the role of gender specificities in the serum levels of cardiac troponins T and I in the diagnostics of ACS, and the specific mechanisms for the formation of gender differences in the serum levels of cardiac troponins T and I are unknown. The purpose of this article is to analyze the role of gender specificities in cardiac troponins T and I in the diagnostics of ACS, and to suggest the most likely mechanisms for the formation of differences in the serum levels of cardiac troponins in men and women.

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Gender based differences in clinical and Angiographic characteristics and outcomes of Acute Coronary Syndrome (ACS) in Asian population

Cited by 8 publications

References 20 publications

Sex Differences in Acute Coronary Syndromes: A Global Perspective

Sex Differences in Acute Coronary Syndromes: A Global Perspective

Impact of COVID-19 on Cardiovascular Disease Presentation, Emergency Department Triage and Inpatient Cardiology Services in a Low- to Middle-Income Country – Perspective from a Tertiary Care Hospital of Pakistan

Gender Specificities of Cardiac Troponin Serum Levels: From Formation Mechanisms to the Diagnostic Role in Case of Acute Coronary Syndrome

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