Impact of comorbidities and gender on the use of coronary interventions in patients with high‐risk non‐<scp>ST</scp>‐segment elevation acute coronary syndrome

Worrall‐Carter, Linda; McEvedy, Samantha; Wilson, Andrew; Rahman, Muhammad Aziz

doi:10.1002/ccd.26117

Cited by 17 publications

(15 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In our study, men were found to be more exposed to chemotherapy at the end of life than women. This sex bias has been described before, both in end‐of‐life care settings and in other settings …”

Section: Discussionsupporting

confidence: 68%

End-of-life care for hospitalized patients with metastatic melanoma in France: a nationwide, register-based study

et al. 2016

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 68%

End-of-life care for hospitalized patients with metastatic melanoma in France: a nationwide, register-based study

et al. 2016

View full text Add to dashboard Cite

show abstract

“…African Americans and Asians were almost 30% less likely to receive CA. Teaching hospital status was associated with a higher use of CA compared to rural hospitals despite the expansion of angiography services in rural hospitals 16 .…”

Section: Discussionmentioning

confidence: 94%

Temporal trends and inequalities in coronary angiography utilization in the management of non-ST-Elevation acute coronary syndromes in the U.S.

Rashid

Fischman

Gulati

et al. 2019

Sci Rep

View full text Add to dashboard Cite

Coronary angiography (CA) is the basis of an invasive management strategy in non-ST elevation acute coronary syndromes (NSTEACS). There are limited contemporary data on national temporal trends in utilization of CA in different patient subgroups. We sought to investigate temporal trends, predictors and clinical outcomes associated with the use of CA in the US. Using the Nationwide Inpatient Sample (NIS) from 2004–2014, we identified all inpatient admissions, age ≥18, with a primary diagnosis of NSTEACS. Descriptive statistics and multivariable logistic regression models were used to investigate temporal trends, predictors and clinical outcomes associated with CA. From a total of 4,380,827 patients, 57.5% received CA during the study period and were more likely to be male, younger and less comorbid as defined per Charlson comorbidity index. The proportion of patients receiving CA increased from 48.5% to 68.5%, however, higher proportional increase was observed in males (53.9% to 69.4% Ptrend < 0.001) and those age ≤60 years (59.0% to 77.9% Ptrend < 0.001). Prior history of CABG (OR 0.33 95%CI 0.35–0.36), previous PCI (OR 0.84 95%CI 0.83–0.86) and previous AMI (OR 0.65 95%CI 0.64–0.67) were inversely related with receipt of CA. Receipt of CA was strongly associated with decreased odds of in-hospital mortality (OR 0.38 95%CI 0.36–0.40). In this national analysis, we observed a temporal increase in utilization of CA albeit slower adoption was noted in older, women and more comorbid patients. The risk-treatment paradox wherein patients who are most likely to benefit were less likely to receive CA persists even in contemporary practice.

show abstract

“…Women, in most instances, are older when they exhibit their first manifestation of ACS, at a mean age of 71.8 years, compared to 65 years for men. 2 , 5 - 10 The older age of onset in women, when compared to men, is probably due to the protective role of estrogen circulation in the vascular endothelium. This hypothesis derives mainly from the observation that the incidence of AMI increases substantially in postmenopausal women.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Differences between Men and Women with Acute Coronary Syndrome. Data from a Brazilian Registry

Soeiro¹,

Silva²,

Roque³

et al. 2018

Arquivos Brasileiros De Cardiologia

View full text Add to dashboard Cite

BackgroundGender-related differences have been reported in patients with acute coronary syndrome. The description of this comparative finding in a Brazilian registry has not yet been documented.ObjectiveTo compare male vs. female patients regarding the baseline characteristics, coronary findings, treatment and in-hospital and long-term prognosis.MethodsThis is a retrospective, multicenter and observational study that included 3,745 patients (2,437 males and 1,308 females) between May 2010 and May 2015. The primary in-hospital outcome was all-cause mortality. The secondary outcome consisted of combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed using the chi-square and the t test, considering p < 0.05 as significant. In the long term, mortality and combined events were assessed using the Kaplan-Meier method, with a mean follow-up of 8.79 months.ResultsThe mean age was 60.3 years for males and 64.6 for females (p < 0.0001). The most prevalent risk factor was systemic arterial hypertension in 72.9% of the women and 67.8% of the men (p = 0.001). Percutaneous coronary intervention was carried out in 44.9% of the males and 35.4% of the females (p < 0.0001), and coronary artery bypass grafting (CABG) was performed in 17% of the males and 11.8% of females (p < 0.0001), with a higher prevalence of three-vessel coronary artery disease in males (27.3% vs. 16.2%, p < 0.0001). Approximately 79.9% of the female patients received a diagnosis of acute coronary syndrome without ST-segment elevation, while in the male patients, this diagnosis was attained in 71.5% (p < 0.0001). No significant differences were observed between the groups in the short and long term, regarding both mortality and the combined events.ConclusionSeveral gender-related differences were observed in patients with acute coronary syndrome regarding the demographic characteristics, coronary artery disease pattern and implemented treatment. However, the prognostic evolution was similar between the groups.

show abstract

Impact of comorbidities and gender on the use of coronary interventions in patients with high‐risk non‐ST‐segment elevation acute coronary syndrome

Abstract: Lower rates of coronary intervention in females persisted after adjusting for number of comorbidities which suggests that gender may bias decisions regarding referral for coronary intervention in high-risk NSTEACS independent of other factors.

Cited by 17 publications

References 38 publications

End-of-life care for hospitalized patients with metastatic melanoma in France: a nationwide, register-based study

End-of-life care for hospitalized patients with metastatic melanoma in France: a nationwide, register-based study

Temporal trends and inequalities in coronary angiography utilization in the management of non-ST-Elevation acute coronary syndromes in the U.S.

Prognostic Differences between Men and Women with Acute Coronary Syndrome. Data from a Brazilian Registry

Contact Info

Product

Resources

About