GENDER SPECIFIC DIFFERENCES IN THE TREATMENT OF PATIENTS WITH ACUTE CORONARY SYNDROMES IN THE CZECH REGISTRY

BACKGROUND: Gender differences in management and worse outcomes in women have been reported in acute coronary syndrome (ACS).
OBJECTIVES: To assess such gender differences in a Czech national registry. To assess impact of national reperfusion network on gender differences in outcomes of patients with ACS.
METHODS: 1921 patients, 788 (41%) women hospitalized for suspected ACS were enrolled in the CZECH registry in November 2005. Data on patients' characteristics, diagnoses, procedures, complications and outcomes were recorded. Odds ratios of in-hospital mortality were calculated using logistic regression models. 1309 patients with confirmed ACS were included in a present analysis.
RESULTS: The diagnosis of ACS was confirmed in 62.3% women compared to 76.4% men (p<0.001). Overall, the women were older than the men (age 7110.4 vs 6411.6 years; p<0.001), had significantly higher rates of hypertension (77.2% vs 65.4%; p<0.001), and diabetes (40.9% vs 25.5%; p<0.001). They had significantly lower rates of prior myocardial infarction (24.3% vs 30.8%; p=0,01) and were less likely ever to have smoked (18.9% vs 30.3%, p<0.001). Medical treatment at admission and at discharge was similar in men and women. Women underwent less often than men in-hospital coronary angiography (79.9% vs. 85.7%; p=0.006) and following revascularization procedures (67% vs. 76%; p<0.001). There were more patients without significant coronary stenosis among the women (6.1% vs. 1.9%; p=0.01). Age-adjusted mortality (both 5.0%) and occurrence of MACE (23.6% vs 24.9%) was similar between men and women.
CONCLUSIONS: The analysis showed gender differences in baseline characteristics. Women were referred less often to in-hospital coronary angiography and revascularisation therapy. Better outcomes of women with ACS in our study may be result of aggressive reperfusion therapy applied.