Sex Differences in the Presentation, Diagnosis, and Management of Acute Coronary Syndromes: Findings From the Kerala-India ACS Registry

Abstract

Background Previous literature from high-income countries has repeatedly shown sex differences in the presentation, diagnosis, and management of acute coronary syndromes (ACS), with women having atypical presentations and undergoing less aggressive diagnostic and therapeutic measures. However, much less data exist evaluating sex differences in ACS in India. Objectives This study sought to evaluate sex differences in the diagnosis, management, and treatment of patients with ACS in Kerala, India. Methods The Kerala ACS Registry collected data from 25,748 consecutive ACS admissions (19,923 men and 5,825 women) from 125 hospitals in the Indian state of Kerala from 2007 to 2009. This study evaluated the association between sex differences in presentation, in-hospital management, and discharge care with in-hospital mortality and in-hospital major adverse cardiovascular events (defined as death, reinfarction, stroke, heart failure, or cardiogenic shock). Results Women with ACS were older than men with ACS (64 vs. 59, p < 0.001) and were more likely to have a history of previous myocardial infarction (16% vs. 14%, p < 0.001). Inpatient diagnostics and management and discharge care were similar between sexes. No significant differences between men and women in the outcome of death (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 0.80 to 1.38) or in the composite outcome of death, reinfarction, stroke, heart failure, or cardiogenic shock (OR: 0.99, 95% CI: 0.79 to 1.25) were seen after adjustment for possible confounding factors. Conclusions In Kerala, even though women with ACS were older and more likely to have previous myocardial infarction, there were no significant differences in in-hospital and discharge management, in-hospital mortality, or major adverse cardiovascular events between sexes. Whether these results apply to other parts of India or acute presentations of other chronic diseases in low- and middle-income countries warrants further study.

Health-Related Quality of Life at 30 Days Among Indian Patients With Acute Myocardial Infarction

“…However, we have previously demonstrated similar treatment and in-hospital clinical outcomes between men and women in Kerala, including death, reinfarction, stroke, heart failure, or cardiogenic shock, after adjustment for baseline differences in comorbidities and presentation. 10 Individuals allocated to the ACS QUIK quality improvement intervention group had higher quality of life scores. We have previously demonstrated higher treatment rates, including reperfusion and anti-angina medications at discharge, in the intervention group compared with the control group.…”

Assessing cardiovascular disease risk factor screening inequalities in India using Lot Quality Assurance Sampling

“…lower incomes and education) are more vulnerable than those with higher socio-economic status [9][10][11][12]. While some evidence suggests that acute coronary outcomes may not vary significantly by sex in India [13], a greater burden of risk factor among males has been observed globally and in Indian studies as well [14][15][16].…”

Secondary prevention of cardiovascular diseases in India: Findings from registries and large cohorts

“…In its initial report, the registry found that ST-elevation myocardial infarction (STEMI) was the most common presentation (37%), followed by non-ST elevation myocardial infarction (NSTEMI) (31%) and unstable angina (32%; P < 0.001 for difference between the groups). 14 A higher proportion of patients with unstable angina had a history of prior diabetes compared with patients who presented with STEMI and non-STEMI (40.7% in unstable angina vs. 37.9% in NSTEMI vs. 34.6% in STEMI), stroke (3.2% vs. 2.2% vs. 2.2%), and percutaneous coronary intervention or coronary artery bypass graft surgery (PCI or CABG) (0.7% vs. 0.1% vs. 0.1%; P < 0.001 for all). On the other hand, history of prior hypertension (40.4% in unstable angina vs. 48.2% in NSTEMI vs. 55.5% in STEMI) and smoking (30.2% vs. 37.9% vs. 35.3%; P < 0.001 for all) was more prevalent among STEMI and non-STEMI patients.…”

“… High rate of missing data. Kerala Acute Coronary Syndrome registry 13 , 14 2013 Patients presenting to the hospital with acute coronary syndrome (ACS). n = 25,748 Observed in-hospital mortality for ACS patients was around 8%.…”