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Three studies find women receive less aggressive ACS treatment

Issue: June 2012

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Data from three studies conducted in China, India and the Middle East presented at the World Congress of Cardiology address sex differences in treatment and risk factors among patients with acute coronary syndromes.

The studies “paint a consistent picture around the world and all serve to demonstrate that women with ACS are, unfortunately, not receiving the same treatment as men,” Sidney C. Smith Jr., MD, president of the World Heart Federation, stated in a press release. “This is something that has to be addressed as a matter of urgency.”

CREATE registry

Analysis of the CREATE registry, comprising more than 20,000 patients in India, revealed that relatively fewer women are admitted to the hospital with ACS. Of the 20,468 patients with ACS from 89 centers in 50 cities in India who were recruited for the registry, only 23.6% were women. All patients were followed for 30 days. Overall, women took 35 minutes longer to reach the hospital from symptom onset, compared with men. Also, women had higher rates of diabetes, hypertension, HF, high heart rate and mean BP. However, researchers found women experienced lower rates of angiography, thrombolysis and coronary interventions. Study results showed no difference in recurrent MI, stroke, HF and bleeding between women and men.

Thirty-day mortality was higher in women after researchers adjusted for age and risk factors (OR=1.24; 95% CI, 1.09-1.43). This result decreased marginally after adjusting for treatments (OR=1.21; 95% CI, 1.05-1.4). According to Prem Pais, MD, of St. John’s Medical College and Research Institute, Bangalore, and colleagues, “variations in characteristics and treatments accounted for about 20% of the increased mortality.

BRIG project

The BRIG project study of 3,168 patients in China demonstrated that a substantial portion of women with ACS did not receive proper treatment during hospitalization compared with men.

For the study, Na Wang, MD, of the Capital Medical University Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Disease, and colleagues recruited 65 hospitals from mainland China and the Hong Kong special administrative region. More than 3,100 patients with ACS completed a questionnaire that included in-hospital medication and procedure information.

Treatment rates of all guideline-recommended strategies were lower in women vs. men. This distinction was more significant in patients with unstable angina. Sixty-eight percent of women with ACS received an ACE inhibitor/angiotensin receptor blocker; 35.1% received clopidogrel/ticlopidine; 88.7% received aspirin; 58.4% received a low–molecular-weight heparin; 66.5% received a beta-blocker; and 66.1% received a statin. Only 8.9% of women received all of the aforementioned medications. In addition, only 24.6% of women received reperfusion therapy.

Analysis in the Middle East

Data from an analysis of three studies that included 4,229 patients with ACS in the Middle East showed that women tended to have more cormorbid disease and received commonly used treatment less frequently than men.

Women in the studies had a higher prevalence of diabetes and hypertension and were more likely to have non–ST-elevation ACS than STEMI vs. men. Researchers noted a trend toward higher in-hospital mortality among women (4.9% vs. 3%), but this finding was not significant.

Women and men received similar amounts of recommended therapies, including aspirin, beta-blockers, ACE/angiotensin II inhibitors and statins, but women received less clopidogrel and glycoprotein IIb/IIIa inhibitors. More than 80% of women and men used reperfusion for STEMI, but the rate of utilization was less in women (80% vs. 89%). This included fewer primary coronary intervention procedures. Use of percutaneous revascularization during index hospitalization was also less likely to occur women; however, women and men had similar rates of utilization of CABG.

Disclosure: Drs. Pais, Smith and Wang report no relevant financial disclosures.