Sex and gender differences in presentation, treatment and outcomes in acute coronary syndrome, a 10 year study from a multi-ethnic Asian population: The Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) registry
Sex and gender differences in acute coronary syndrome (ACS) have been well studied in the western population. However, limited studies have examined the trends of these differences in a multi-ethnic Asian population. To study the trends in sex and gender differences in ACS using the Malaysian NCVD-A...
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| description | Sex and gender differences in acute coronary syndrome (ACS) have been well studied in the western population. However, limited studies have examined the trends of these differences in a multi-ethnic Asian population.
To study the trends in sex and gender differences in ACS using the Malaysian NCVD-ACS Registry.
Data from 24 hospitals involving 35,232 ACS patients (79.44% men and 20.56% women) from 1st. Jan 2012 to 31st. Dec 2016 were analysed. Data were collected on demographic characteristics, coronary risk factors, anthropometrics, treatments and outcomes. Analyses were done for ACS as a whole and separately for ST-segment elevation myocardial infarction (STEMI), Non-STEMI and unstable angina. These were then compared to published data from March 2006 to February 2010 which included 13,591 ACS patients (75.8% men and 24.2% women).
Women were older and more likely to have diabetes mellitus, hypertension, dyslipidemia, previous heart failure and renal failure than men. Women remained less likely to receive aspirin, beta-blocker, angiotensin-converting enzyme inhibitor (ACE-I) and statin. Women were less likely to undergo angiography and percutaneous coronary intervention (PCI) despite an overall increase. In the STEMI cohort, despite a marked increase in presentation with Killip class IV, women were less likely to received primary PCI or fibrinolysis and had longer median door-to-needle and door-to-balloon time compared to men, although these had improved. Women had higher unadjusted in-hospital, 30-Day and 1-year mortality rates compared to men for the STEMI and NSTEMI cohorts. After multivariate adjustments, 1-year mortality remained significantly higher for women with STEMI (adjusted OR: 1.31 (1.09-1.57), p |
| doi_str_mv | 10.1371/journal.pone.0246474 |
| format | Article |
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To study the trends in sex and gender differences in ACS using the Malaysian NCVD-ACS Registry.
Data from 24 hospitals involving 35,232 ACS patients (79.44% men and 20.56% women) from 1st. Jan 2012 to 31st. Dec 2016 were analysed. Data were collected on demographic characteristics, coronary risk factors, anthropometrics, treatments and outcomes. Analyses were done for ACS as a whole and separately for ST-segment elevation myocardial infarction (STEMI), Non-STEMI and unstable angina. These were then compared to published data from March 2006 to February 2010 which included 13,591 ACS patients (75.8% men and 24.2% women).
Women were older and more likely to have diabetes mellitus, hypertension, dyslipidemia, previous heart failure and renal failure than men. Women remained less likely to receive aspirin, beta-blocker, angiotensin-converting enzyme inhibitor (ACE-I) and statin. Women were less likely to undergo angiography and percutaneous coronary intervention (PCI) despite an overall increase. In the STEMI cohort, despite a marked increase in presentation with Killip class IV, women were less likely to received primary PCI or fibrinolysis and had longer median door-to-needle and door-to-balloon time compared to men, although these had improved. Women had higher unadjusted in-hospital, 30-Day and 1-year mortality rates compared to men for the STEMI and NSTEMI cohorts. After multivariate adjustments, 1-year mortality remained significantly higher for women with STEMI (adjusted OR: 1.31 (1.09-1.57), p<0.003) but were no longer significant for NSTEMI cohort.
Women continued to have longer system delays, receive less aggressive pharmacotherapies and invasive treatments with poorer outcome. There is an urgent need for increased effort from all stakeholders if we are to narrow this gap.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0246474</identifier><identifier>PMID: 33556136</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acute coronary syndrome ; Acute coronary syndromes ; Balloon treatment ; Biology and Life Sciences ; Bleeding ; Blood vessels ; Body mass ; Body mass index ; Body size ; Cardiology ; Cardiovascular disease ; Cardiovascular diseases ; Care and treatment ; Cigarette smoking ; Complications ; Congestive heart failure ; Demographic aspects ; Diabetes mellitus ; Dyslipidemia ; Editing ; Electronic mail ; Gender ; Gender aspects ; Gender differences ; Health care facilities ; Health risks ; Health services ; Heart attacks ; Heart diseases ; Hypertension ; Medical treatment ; Medicine and Health Sciences ; Minority & ethnic groups ; Mortality ; Myocardial infarction ; Organizational aspects ; Patient outcomes ; Renal failure ; Research facilities ; Reviews ; Risk analysis ; Risk factors ; Sex ; Sex differences ; Stroke ; Visualization</subject><ispartof>PloS one, 2021-02, Vol.16 (2), p.e0246474-e0246474</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Lee et al 2021 Lee et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c593t-8b2c3c180c87c65754477b1a490b93a131cf985bf43e9a81146b12a488b48fa23</citedby><cites>FETCH-LOGICAL-c593t-8b2c3c180c87c65754477b1a490b93a131cf985bf43e9a81146b12a488b48fa23</cites><orcidid>0000-0002-6675-1312 ; 0000-0002-7706-2811</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869989/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869989/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33556136$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Widmer, R. Jay</contributor><creatorcontrib>Lee, Chuey Yan</creatorcontrib><creatorcontrib>Liu, Kien Ting</creatorcontrib><creatorcontrib>Lu, Hou Tee</creatorcontrib><creatorcontrib>Mohd Ali, Rosli</creatorcontrib><creatorcontrib>Fong, Alan Yean Yip</creatorcontrib><creatorcontrib>Wan Ahmad, Wan Azman</creatorcontrib><title>Sex and gender differences in presentation, treatment and outcomes in acute coronary syndrome, a 10 year study from a multi-ethnic Asian population: The Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) registry</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Sex and gender differences in acute coronary syndrome (ACS) have been well studied in the western population. However, limited studies have examined the trends of these differences in a multi-ethnic Asian population.
To study the trends in sex and gender differences in ACS using the Malaysian NCVD-ACS Registry.
Data from 24 hospitals involving 35,232 ACS patients (79.44% men and 20.56% women) from 1st. Jan 2012 to 31st. Dec 2016 were analysed. Data were collected on demographic characteristics, coronary risk factors, anthropometrics, treatments and outcomes. Analyses were done for ACS as a whole and separately for ST-segment elevation myocardial infarction (STEMI), Non-STEMI and unstable angina. These were then compared to published data from March 2006 to February 2010 which included 13,591 ACS patients (75.8% men and 24.2% women).
Women were older and more likely to have diabetes mellitus, hypertension, dyslipidemia, previous heart failure and renal failure than men. Women remained less likely to receive aspirin, beta-blocker, angiotensin-converting enzyme inhibitor (ACE-I) and statin. Women were less likely to undergo angiography and percutaneous coronary intervention (PCI) despite an overall increase. In the STEMI cohort, despite a marked increase in presentation with Killip class IV, women were less likely to received primary PCI or fibrinolysis and had longer median door-to-needle and door-to-balloon time compared to men, although these had improved. Women had higher unadjusted in-hospital, 30-Day and 1-year mortality rates compared to men for the STEMI and NSTEMI cohorts. After multivariate adjustments, 1-year mortality remained significantly higher for women with STEMI (adjusted OR: 1.31 (1.09-1.57), p<0.003) but were no longer significant for NSTEMI cohort.
Women continued to have longer system delays, receive less aggressive pharmacotherapies and invasive treatments with poorer outcome. There is an urgent need for increased effort from all stakeholders if we are to narrow this gap.</description><subject>Acute coronary syndrome</subject><subject>Acute coronary syndromes</subject><subject>Balloon treatment</subject><subject>Biology and Life Sciences</subject><subject>Bleeding</subject><subject>Blood vessels</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Care and treatment</subject><subject>Cigarette smoking</subject><subject>Complications</subject><subject>Congestive heart failure</subject><subject>Demographic aspects</subject><subject>Diabetes mellitus</subject><subject>Dyslipidemia</subject><subject>Editing</subject><subject>Electronic mail</subject><subject>Gender</subject><subject>Gender aspects</subject><subject>Gender differences</subject><subject>Health care facilities</subject><subject>Health risks</subject><subject>Health services</subject><subject>Heart attacks</subject><subject>Heart diseases</subject><subject>Hypertension</subject><subject>Medical treatment</subject><subject>Medicine and Health Sciences</subject><subject>Minority & ethnic groups</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Organizational aspects</subject><subject>Patient outcomes</subject><subject>Renal failure</subject><subject>Research facilities</subject><subject>Reviews</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Sex</subject><subject>Sex differences</subject><subject>Stroke</subject><subject>Visualization</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNptU01v1DAQjRCIlsI_QGCJS5GaxY4dx-GAtNrlo1Iphxau1sRxtq4Se7Gdiv3lXPHuplWLKh_ivHnz5o3tybLXBM8IrciHazd6C_1s7aye4YJxVrEn2SGpaZHzAtOn9_YH2YsQrjEuqeD8eXZAaVlyQvlh9vdC_0FgW7TSttUetabrtNdW6YCMRWuvg7YRonH2BEWvIQ7pf5fhxqjcsOeBGqNGynlnwW9Q2NjWp9gJAkQw2mjwKMSx3aAuwQkcxj6aXMcraxSaBwOplFuP_a7QR3R5pdF36GGzi5zvUOjRAnxr3A0ElZgeLU3QEDRaQoQmbfL5zsXi1sXF5AIdny9-LfP54uI98nplQvSbl9mzDvqgX03fo-znl8-Xi2_52Y-vp4v5Wa7KmsZcNIWiigisRKV4WZWMVVVDgNW4qSkQSlRXi7LpGNU1CEIYb0gBTIiGiQ4KepS93euuexfkdGdBFkxUrChJtWWc7hmtg2u59mZI3qUDI3eA8ysJPhrVa0kVJx0r2NYSg5oJzHGpyrIQBauEYknr01RtbAbdqnRVHvoHog8j1lzJlbuRleB1LeokcDwJePd71CHKwQSl-x6sduPed5WOoKaJ-u4_6uPdTawVpAaM7Vyqq7aics5LQjiu8db37BFWWq0ejEoPvDMJf5DA9gnKuxC87u56JFhux-PWjNyOh5zGI6W9uX8-d0m380D_AQu7D8Q</recordid><startdate>20210208</startdate><enddate>20210208</enddate><creator>Lee, 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and gender differences in presentation, treatment and outcomes in acute coronary syndrome, a 10 year study from a multi-ethnic Asian population: The Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) registry</title><author>Lee, Chuey Yan ; Liu, Kien Ting ; Lu, Hou Tee ; Mohd Ali, Rosli ; Fong, Alan Yean Yip ; Wan Ahmad, Wan Azman</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c593t-8b2c3c180c87c65754477b1a490b93a131cf985bf43e9a81146b12a488b48fa23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acute coronary syndrome</topic><topic>Acute coronary syndromes</topic><topic>Balloon treatment</topic><topic>Biology and Life Sciences</topic><topic>Bleeding</topic><topic>Blood vessels</topic><topic>Body mass</topic><topic>Body mass index</topic><topic>Body size</topic><topic>Cardiology</topic><topic>Cardiovascular 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Yean Yip</au><au>Wan Ahmad, Wan Azman</au><au>Widmer, R. Jay</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sex and gender differences in presentation, treatment and outcomes in acute coronary syndrome, a 10 year study from a multi-ethnic Asian population: The Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) registry</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-02-08</date><risdate>2021</risdate><volume>16</volume><issue>2</issue><spage>e0246474</spage><epage>e0246474</epage><pages>e0246474-e0246474</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Sex and gender differences in acute coronary syndrome (ACS) have been well studied in the western population. However, limited studies have examined the trends of these differences in a multi-ethnic Asian population.
To study the trends in sex and gender differences in ACS using the Malaysian NCVD-ACS Registry.
Data from 24 hospitals involving 35,232 ACS patients (79.44% men and 20.56% women) from 1st. Jan 2012 to 31st. Dec 2016 were analysed. Data were collected on demographic characteristics, coronary risk factors, anthropometrics, treatments and outcomes. Analyses were done for ACS as a whole and separately for ST-segment elevation myocardial infarction (STEMI), Non-STEMI and unstable angina. These were then compared to published data from March 2006 to February 2010 which included 13,591 ACS patients (75.8% men and 24.2% women).
Women were older and more likely to have diabetes mellitus, hypertension, dyslipidemia, previous heart failure and renal failure than men. Women remained less likely to receive aspirin, beta-blocker, angiotensin-converting enzyme inhibitor (ACE-I) and statin. Women were less likely to undergo angiography and percutaneous coronary intervention (PCI) despite an overall increase. In the STEMI cohort, despite a marked increase in presentation with Killip class IV, women were less likely to received primary PCI or fibrinolysis and had longer median door-to-needle and door-to-balloon time compared to men, although these had improved. Women had higher unadjusted in-hospital, 30-Day and 1-year mortality rates compared to men for the STEMI and NSTEMI cohorts. After multivariate adjustments, 1-year mortality remained significantly higher for women with STEMI (adjusted OR: 1.31 (1.09-1.57), p<0.003) but were no longer significant for NSTEMI cohort.
Women continued to have longer system delays, receive less aggressive pharmacotherapies and invasive treatments with poorer outcome. There is an urgent need for increased effort from all stakeholders if we are to narrow this gap.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33556136</pmid><doi>10.1371/journal.pone.0246474</doi><orcidid>https://orcid.org/0000-0002-6675-1312</orcidid><orcidid>https://orcid.org/0000-0002-7706-2811</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | PloS one, 2021-02, Vol.16 (2), p.e0246474-e0246474 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2487425172 |
| source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acute coronary syndrome Acute coronary syndromes Balloon treatment Biology and Life Sciences Bleeding Blood vessels Body mass Body mass index Body size Cardiology Cardiovascular disease Cardiovascular diseases Care and treatment Cigarette smoking Complications Congestive heart failure Demographic aspects Diabetes mellitus Dyslipidemia Editing Electronic mail Gender Gender aspects Gender differences Health care facilities Health risks Health services Heart attacks Heart diseases Hypertension Medical treatment Medicine and Health Sciences Minority & ethnic groups Mortality Myocardial infarction Organizational aspects Patient outcomes Renal failure Research facilities Reviews Risk analysis Risk factors Sex Sex differences Stroke Visualization |
| title | Sex and gender differences in presentation, treatment and outcomes in acute coronary syndrome, a 10 year study from a multi-ethnic Asian population: The Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) registry |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-29T07%3A49%3A48IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Sex%20and%20gender%20differences%20in%20presentation,%20treatment%20and%20outcomes%20in%20acute%20coronary%20syndrome,%20a%2010%20year%20study%20from%20a%20multi-ethnic%20Asian%20population:%20The%20Malaysian%20National%20Cardiovascular%20Disease%20Database-Acute%20Coronary%20Syndrome%20(NCVD-ACS)%20registry&rft.jtitle=PloS%20one&rft.au=Lee,%20Chuey%20Yan&rft.date=2021-02-08&rft.volume=16&rft.issue=2&rft.spage=e0246474&rft.epage=e0246474&rft.pages=e0246474-e0246474&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0246474&rft_dat=%3Cgale_plos_%3EA651160904%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2487425172&rft_id=info:pmid/33556136&rft_galeid=A651160904&rft_doaj_id=oai_doaj_org_article_3c61f424c3c14a9480605c55282478c4&rfr_iscdi=true |