A registry that examined the treatment patterns and outcome of Acute Coronary Syndrome patients with renal dysfunction.
a) Background:
Treatments and outcomes in acute coronary syndromes (ACS) are influenced by patient characteristics including gender. There are no data on gender differences from a representative sample across India. We conducted a large multi center ACS study in India and analyzed one-month outcome
b) Aim/objective:
To study the differences between men and women in the treatments and outcomes of ACS in India
c) Methods:
We prospectively recruited 20,468 ACS patients from 89 centers in 50 cities in India and followed up to 30 days. We recorded and analyzed differences in risk factors, time to hospital and treatments, outcomes and the factors that influenced the outcomes.
d) Results:
Of the 20,468 patients, 4,826 (23.6%) were women. The overall mean age was 57.5 (12.03) and women were older by 4 years compared to men. The patients reached hospital in 360 min from symptom onset; women took 35 min longer than men (p<0.0001). Except for smoking, women compared to men had higher rates of diabetes (37.9 vs. 28.3%), hypertension (52.3 vs 33.3%), heart failure at presentation (Killip >2, 18.2 vs. 15.3%), high heart rate (86.3 vs. 82.7%) and mean BP (139.3/86.6 vs. 133.0/85.5). The rates of angiography (19.3 vs 24.0%), pharmacological thrombolysis (30.9 vs 44.9%) and coronary interventions (6.1% vs 7.7%) were also lower in women as were in-hospital use of antiplatelets (97.6 vs. 98.3%), lipid lowering drugs (50.6 vs. 53.0%) and angiotensin converting inhibitors/ angiotensin receptor blockers (54.6 vs. 56.4%) (p<0.003). At 30 days 413 (8.6%) women and 968 (6.2%) men died, a 39% difference (p<0.01). After adjusting for age and risk factors, the 30-day mortality was greater in women (odds ratio 1.24, 95% confidence interval 1.09-1.43) and decreased marginally after adjusting for treatments (1.21, 1.05-1.40).
e) Total recruitment & no. of sites: Global – NA, India – 20468 from 122 sites
f) Conclusion:
Relatively fewer women in India are admitted with ACS. Women are older, reach hospital late, have more risk factors, receive inferior treatments and have worse outcomes. Variations in characteristics and treatments accounted for about 20% of the increased mortality. We need strategies to ensure women get better treatments and have improved outcomes.
g) Publication status (Name & year): Lancet 2008
h) Publication link: https://www.sciencedirect.com/science/article/pii/S0140673608606236?via%3Dihub
i) Updated as on: 30th Jun 2023