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J Am Coll Cardiol, 2005; 45:832-837, doi:10.1016/j.jacc.2004.11.055
© 2005 by the American College of Cardiology Foundation
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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

Andra L. Blomkalns, MD*,*, Anita Y. Chen, MS{dagger}, Judith S. Hochman, MD{ddagger}, Eric D. Peterson, MD, MPH{dagger}, Kelly Trynosky, RN§, Deborah B. Diercks, MD||, Gerard X. Brogan, Jr, MD, William E. Boden, MD#, Matthew T. Roe, MD, MHS{dagger}, E. Magnus Ohman, MD**, W. Brian Gibler, MD*, L. Kristin Newby, MD, MHS{dagger} CRUSADE Investigators

* Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
{dagger} Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
{ddagger} Division of Cardiology, New York University School of Medicine, New York, New York
§ Ephrata Community Hospital, Ephrata, Pennsylvania
|| Department of Emergency Medicine, University of California-Davis, Sacramento, California
Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
# Division of Cardiology, Hartford Hospital, Hartford, Connecticut
** Division of Cardiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina

Manuscript received July 20, 2004; revised manuscript received November 22, 2004, accepted November 29, 2004.

* Reprint requests and correspondence: Dr. Andra L. Blomkalns, Assistant Professor, Department of Emergency Medicine, Mail Location 0769, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, Ohio 45267-0769 (Email: Andra.Blomkalns{at}uc.edu).

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




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