Clinical research
Acute coronary syndromes
Gender disparities in the diagnosis and treatment of non–ST-segment elevation acute coronary syndromes: Large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative

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Objectives

We hypothesized that significant disparities in gender exist in the management of patients with non–ST-segment elevation (NSTE) acute coronary syndromes (ACS).

Background

Gender-related differences in the diagnosis and treatment of ACS have important healthcare implications. No large-scale examination of these disparities has been completed since the publication of the revised American College of Cardiology/American Heart Association guidelines for management of patients with NSTE ACS.

Methods

Using data from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative, we examined differences of gender in treatment and outcomes among patients with NSTE ACS.

Results

Women (41% of 35,875 patients) were older (median age 73 vs. 65 years) and more often had diabetes and hypertension. Women were less likely to receive acute heparin, angiotensin-converting enzyme inhibitors, and glycoprotein IIb/IIIa inhibitors and less commonly received aspirin, angiotensin-converting enzyme inhibitors, and statins at discharge. The use of cardiac catheterization and revascularization was higher in men, but among patients with significant coronary disease, percutaneous revascularization was performed in a similar proportion of women and men. Women were at higher risk for unadjusted in-hospital death (5.6% vs. 4.3%), reinfarction (4.0% vs. 3.5%), heart failure (12.1% vs. 8.8%), stroke (1.1% vs. 0.8%), and red blood cell transfusion (17.2% vs. 13.2%), but after adjustment, only transfusion was higher in women.

Conclusions

Despite presenting with higher risk characteristics and having higher in-hospital risk, women with NSTE ACS are treated less aggressively than men.

Abbreviations and acronyms

ACC
American College of Cardiology
ACS
acute coronary syndromes
AHA
American Heart Association
CRUSADE
Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines
GP
glycoprotein
MI
myocardial infarction
NSTE
non–ST-segment elevation

Cited by (0)

The CRUSADE initiative is funded by Millennium Pharmaceuticals Inc. (Cambridge, Massachusetts) and Schering Corp. (Kenilworth, New Jersey). Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership provides an unrestricted grant in support of the program. Drs. Peterson and Roe serve on the Speakers' Bureau for Millennium Pharmaceuticals Inc. and Schering Corp. Dr. Roe serves on the speakers' bureau for Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. Drs. Peterson, Roe, Ohman, Gibler, and Newby have research grants from Millennium Pharmaceuticals Inc., and research grants from Schering Corp. Drs. Peterson, Boden, Roe, Ohman, Gibler, and Newby have research grants from Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. Dr. Diercks has consulting relationships with Millennium Pharmaceuticals Inc. and Schering Corp.