Impact of comorbidities and gender on the use of coronary interventions in patients with high-risk non-ST-segment elevation acute coronary syndrome
Objectives To determine the impact of gender and comorbidity on use of coronary interventions in patients diagnosed with high‐risk non‐ST‐segment acute coronary syndrome (NSTEACS). Background Guidelines recommend the use of coronary angiography for all patients diagnosed with NSTEACS with high‐risk...
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| Veröffentlicht in: | Catheterization and cardiovascular interventions 2016-03, Vol.87 (4), p.E128-E136 |
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| creator | Worrall-Carter, Linda McEvedy, Samantha Wilson, Andrew Rahman, Muhammad Aziz |
| description | Objectives
To determine the impact of gender and comorbidity on use of coronary interventions in patients diagnosed with high‐risk non‐ST‐segment acute coronary syndrome (NSTEACS).
Background
Guidelines recommend the use of coronary angiography for all patients diagnosed with NSTEACS with high‐risk features, except in the presence of severe comorbidities. However, little is understood about the relationship between gender, comorbidity, and the use of coronary interventions.
Methods
Retrospective analyses of the Victorian Admitted Episodes Data Set (VAED) including all patients diagnosed with NSTEACS with high‐risk features on their first admission for ACS between June 2007 and July 2009. Hierarchical logistic regression models and correspondence analyses were used to understand the relationship between gender, comorbidities, and the use of coronary interventions.
Results
Out of 16,771 NSTEACS patients with high‐risk features, 6,338 (38%) were female. Females were older than males (aged ≥75: 62% vs 39%, p |
| doi_str_mv | 10.1002/ccd.26117 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1775178200</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3990886871</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3917-f2e430d7adf8028d859d6957d6455c48559a5f3285a2236ac163e508561456d73</originalsourceid><addsrcrecordid>eNp1kctu1DAUhiMEohdY8ALIEhu6SOtLbCdLlMJQqYUFBbqzXPtkxm1iD3bSMs_BC-Mh0yIhsfKxzvd_svUXxSuCjwnG9MQYe0wFIfJJsU84paWk4urpbiZNJfaKg5RuMMaNoM3zYo8KKmVdN_vFr7Nhrc2IQodMGEK8dtaNDhLS3qIleAsRBY_GFaApwYzF4HXcIOdHiHfgRxd8yje01jnpx4Tu3bhCK7dcldGlW-SDL79clgmWQ14j6OFOb0NIm2mEv8K08TaGAV4UzzrdJ3i5Ow-Lrx_eX7Yfy_PPi7P23XlpWENk2VGoGLZS267GtLY1b6xouLSi4txUNeeN5h2jNdeUMqENEQw4rrkgFRdWssPi7exdx_BjgjSqwSUDfa89hCkpIiUnsqYYZ_TNP-hNmKLPr9tSFaub7M3U0UyZGFKK0Kl1dEP-miJYbZtSuSn1p6nMvt4Zp-sB7CP5UE0GTmbg3vWw-b9Jte3pg7KcEy6N8PMxoeOtEpJJrr5_WqjFBfsmLtpTdcV-A4mfrRo</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1774389085</pqid></control><display><type>article</type><title>Impact of comorbidities and gender on the use of coronary interventions in patients with high-risk non-ST-segment elevation acute coronary syndrome</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Worrall-Carter, Linda ; McEvedy, Samantha ; Wilson, Andrew ; Rahman, Muhammad Aziz</creator><creatorcontrib>Worrall-Carter, Linda ; McEvedy, Samantha ; Wilson, Andrew ; Rahman, Muhammad Aziz</creatorcontrib><description>Objectives
To determine the impact of gender and comorbidity on use of coronary interventions in patients diagnosed with high‐risk non‐ST‐segment acute coronary syndrome (NSTEACS).
Background
Guidelines recommend the use of coronary angiography for all patients diagnosed with NSTEACS with high‐risk features, except in the presence of severe comorbidities. However, little is understood about the relationship between gender, comorbidity, and the use of coronary interventions.
Methods
Retrospective analyses of the Victorian Admitted Episodes Data Set (VAED) including all patients diagnosed with NSTEACS with high‐risk features on their first admission for ACS between June 2007 and July 2009. Hierarchical logistic regression models and correspondence analyses were used to understand the relationship between gender, comorbidities, and the use of coronary interventions.
Results
Out of 16,771 NSTEACS patients with high‐risk features, 6,338 (38%) were female. Females were older than males (aged ≥75: 62% vs 39%, p < 0.001) and more likely to have multiple comorbidities (≥2: 66% vs 59%, p < 0.001). After adjusting for potential confounders, females were more likely to receive no coronary intervention than males with a similar number of comorbid conditions (no comorbidities: OR 1.62, 95% CI 1.28–2.05; 1 comorbidity: OR 1.67, 95% CI 1.44–1.93; 2 comorbidities: OR 1.93, 95% CI 1.66–2.23; ≥3 comorbidities: OR 1.42, 95% CI 1.27–1.60).
Conclusions
Lower rates of coronary intervention in females persisted after adjusting for number of comorbidities which suggests that gender may bias decisions regarding referral for coronary intervention in high‐risk NSTEACS independent of other factors. © 2015 Wiley Periodicals, Inc.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.26117</identifier><identifier>PMID: 26277889</identifier><identifier>CODEN: CARIF2</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Acute Coronary Syndrome - diagnostic imaging ; Acute Coronary Syndrome - mortality ; Acute Coronary Syndrome - therapy ; Acute coronary syndromes ; Adolescent ; Adult ; Age Factors ; Aged ; Angina pectoris ; angiogram ; Comorbidity ; Coronary Angiography ; coronary heart disease ; correspondence analysis ; Databases, Factual ; Female ; Gender ; Healthcare Disparities ; Heart attacks ; Humans ; Intervention ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Non-ST Elevated Myocardial Infarction - diagnostic imaging ; Non-ST Elevated Myocardial Infarction - mortality ; Non-ST Elevated Myocardial Infarction - therapy ; Odds Ratio ; percutaneous coronary intervention ; Percutaneous Coronary Intervention - adverse effects ; Percutaneous Coronary Intervention - mortality ; Percutaneous Coronary Intervention - utilization ; Retrospective Studies ; Risk Factors ; Sex Factors ; Treatment Outcome ; Victoria - epidemiology ; women ; Young Adult</subject><ispartof>Catheterization and cardiovascular interventions, 2016-03, Vol.87 (4), p.E128-E136</ispartof><rights>2015 Wiley Periodicals, Inc.</rights><rights>2016 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3917-f2e430d7adf8028d859d6957d6455c48559a5f3285a2236ac163e508561456d73</citedby><cites>FETCH-LOGICAL-c3917-f2e430d7adf8028d859d6957d6455c48559a5f3285a2236ac163e508561456d73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fccd.26117$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.26117$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26277889$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Worrall-Carter, Linda</creatorcontrib><creatorcontrib>McEvedy, Samantha</creatorcontrib><creatorcontrib>Wilson, Andrew</creatorcontrib><creatorcontrib>Rahman, Muhammad Aziz</creatorcontrib><title>Impact of comorbidities and gender on the use of coronary interventions in patients with high-risk non-ST-segment elevation acute coronary syndrome</title><title>Catheterization and cardiovascular interventions</title><addtitle>Cathet. Cardiovasc. Intervent</addtitle><description>Objectives
To determine the impact of gender and comorbidity on use of coronary interventions in patients diagnosed with high‐risk non‐ST‐segment acute coronary syndrome (NSTEACS).
Background
Guidelines recommend the use of coronary angiography for all patients diagnosed with NSTEACS with high‐risk features, except in the presence of severe comorbidities. However, little is understood about the relationship between gender, comorbidity, and the use of coronary interventions.
Methods
Retrospective analyses of the Victorian Admitted Episodes Data Set (VAED) including all patients diagnosed with NSTEACS with high‐risk features on their first admission for ACS between June 2007 and July 2009. Hierarchical logistic regression models and correspondence analyses were used to understand the relationship between gender, comorbidities, and the use of coronary interventions.
Results
Out of 16,771 NSTEACS patients with high‐risk features, 6,338 (38%) were female. Females were older than males (aged ≥75: 62% vs 39%, p < 0.001) and more likely to have multiple comorbidities (≥2: 66% vs 59%, p < 0.001). After adjusting for potential confounders, females were more likely to receive no coronary intervention than males with a similar number of comorbid conditions (no comorbidities: OR 1.62, 95% CI 1.28–2.05; 1 comorbidity: OR 1.67, 95% CI 1.44–1.93; 2 comorbidities: OR 1.93, 95% CI 1.66–2.23; ≥3 comorbidities: OR 1.42, 95% CI 1.27–1.60).
Conclusions
Lower rates of coronary intervention in females persisted after adjusting for number of comorbidities which suggests that gender may bias decisions regarding referral for coronary intervention in high‐risk NSTEACS independent of other factors. © 2015 Wiley Periodicals, Inc.</description><subject>Acute Coronary Syndrome - diagnostic imaging</subject><subject>Acute Coronary Syndrome - mortality</subject><subject>Acute Coronary Syndrome - therapy</subject><subject>Acute coronary syndromes</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Angina pectoris</subject><subject>angiogram</subject><subject>Comorbidity</subject><subject>Coronary Angiography</subject><subject>coronary heart disease</subject><subject>correspondence analysis</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Gender</subject><subject>Healthcare Disparities</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Intervention</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Non-ST Elevated Myocardial Infarction - diagnostic imaging</subject><subject>Non-ST Elevated Myocardial Infarction - mortality</subject><subject>Non-ST Elevated Myocardial Infarction - therapy</subject><subject>Odds Ratio</subject><subject>percutaneous coronary intervention</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Percutaneous Coronary Intervention - mortality</subject><subject>Percutaneous Coronary Intervention - utilization</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>Treatment Outcome</subject><subject>Victoria - epidemiology</subject><subject>women</subject><subject>Young Adult</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kctu1DAUhiMEohdY8ALIEhu6SOtLbCdLlMJQqYUFBbqzXPtkxm1iD3bSMs_BC-Mh0yIhsfKxzvd_svUXxSuCjwnG9MQYe0wFIfJJsU84paWk4urpbiZNJfaKg5RuMMaNoM3zYo8KKmVdN_vFr7Nhrc2IQodMGEK8dtaNDhLS3qIleAsRBY_GFaApwYzF4HXcIOdHiHfgRxd8yje01jnpx4Tu3bhCK7dcldGlW-SDL79clgmWQ14j6OFOb0NIm2mEv8K08TaGAV4UzzrdJ3i5Ow-Lrx_eX7Yfy_PPi7P23XlpWENk2VGoGLZS267GtLY1b6xouLSi4txUNeeN5h2jNdeUMqENEQw4rrkgFRdWssPi7exdx_BjgjSqwSUDfa89hCkpIiUnsqYYZ_TNP-hNmKLPr9tSFaub7M3U0UyZGFKK0Kl1dEP-miJYbZtSuSn1p6nMvt4Zp-sB7CP5UE0GTmbg3vWw-b9Jte3pg7KcEy6N8PMxoeOtEpJJrr5_WqjFBfsmLtpTdcV-A4mfrRo</recordid><startdate>201603</startdate><enddate>201603</enddate><creator>Worrall-Carter, Linda</creator><creator>McEvedy, Samantha</creator><creator>Wilson, Andrew</creator><creator>Rahman, Muhammad Aziz</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201603</creationdate><title>Impact of comorbidities and gender on the use of coronary interventions in patients with high-risk non-ST-segment elevation acute coronary syndrome</title><author>Worrall-Carter, Linda ; McEvedy, Samantha ; Wilson, Andrew ; Rahman, Muhammad Aziz</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3917-f2e430d7adf8028d859d6957d6455c48559a5f3285a2236ac163e508561456d73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Acute Coronary Syndrome - diagnostic imaging</topic><topic>Acute Coronary Syndrome - mortality</topic><topic>Acute Coronary Syndrome - therapy</topic><topic>Acute coronary syndromes</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Angina pectoris</topic><topic>angiogram</topic><topic>Comorbidity</topic><topic>Coronary Angiography</topic><topic>coronary heart disease</topic><topic>correspondence analysis</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Gender</topic><topic>Healthcare Disparities</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Intervention</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Non-ST Elevated Myocardial Infarction - diagnostic imaging</topic><topic>Non-ST Elevated Myocardial Infarction - mortality</topic><topic>Non-ST Elevated Myocardial Infarction - therapy</topic><topic>Odds Ratio</topic><topic>percutaneous coronary intervention</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Percutaneous Coronary Intervention - mortality</topic><topic>Percutaneous Coronary Intervention - utilization</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>Treatment Outcome</topic><topic>Victoria - epidemiology</topic><topic>women</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Worrall-Carter, Linda</creatorcontrib><creatorcontrib>McEvedy, Samantha</creatorcontrib><creatorcontrib>Wilson, Andrew</creatorcontrib><creatorcontrib>Rahman, Muhammad Aziz</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Worrall-Carter, Linda</au><au>McEvedy, Samantha</au><au>Wilson, Andrew</au><au>Rahman, Muhammad Aziz</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of comorbidities and gender on the use of coronary interventions in patients with high-risk non-ST-segment elevation acute coronary syndrome</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Cathet. Cardiovasc. Intervent</addtitle><date>2016-03</date><risdate>2016</risdate><volume>87</volume><issue>4</issue><spage>E128</spage><epage>E136</epage><pages>E128-E136</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><coden>CARIF2</coden><abstract>Objectives
To determine the impact of gender and comorbidity on use of coronary interventions in patients diagnosed with high‐risk non‐ST‐segment acute coronary syndrome (NSTEACS).
Background
Guidelines recommend the use of coronary angiography for all patients diagnosed with NSTEACS with high‐risk features, except in the presence of severe comorbidities. However, little is understood about the relationship between gender, comorbidity, and the use of coronary interventions.
Methods
Retrospective analyses of the Victorian Admitted Episodes Data Set (VAED) including all patients diagnosed with NSTEACS with high‐risk features on their first admission for ACS between June 2007 and July 2009. Hierarchical logistic regression models and correspondence analyses were used to understand the relationship between gender, comorbidities, and the use of coronary interventions.
Results
Out of 16,771 NSTEACS patients with high‐risk features, 6,338 (38%) were female. Females were older than males (aged ≥75: 62% vs 39%, p < 0.001) and more likely to have multiple comorbidities (≥2: 66% vs 59%, p < 0.001). After adjusting for potential confounders, females were more likely to receive no coronary intervention than males with a similar number of comorbid conditions (no comorbidities: OR 1.62, 95% CI 1.28–2.05; 1 comorbidity: OR 1.67, 95% CI 1.44–1.93; 2 comorbidities: OR 1.93, 95% CI 1.66–2.23; ≥3 comorbidities: OR 1.42, 95% CI 1.27–1.60).
Conclusions
Lower rates of coronary intervention in females persisted after adjusting for number of comorbidities which suggests that gender may bias decisions regarding referral for coronary intervention in high‐risk NSTEACS independent of other factors. © 2015 Wiley Periodicals, Inc.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>26277889</pmid><doi>10.1002/ccd.26117</doi><tpages>9</tpages></addata></record> |
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| source | MEDLINE; Access via Wiley Online Library |
| subjects | Acute Coronary Syndrome - diagnostic imaging Acute Coronary Syndrome - mortality Acute Coronary Syndrome - therapy Acute coronary syndromes Adolescent Adult Age Factors Aged Angina pectoris angiogram Comorbidity Coronary Angiography coronary heart disease correspondence analysis Databases, Factual Female Gender Healthcare Disparities Heart attacks Humans Intervention Logistic Models Male Middle Aged Multivariate Analysis Non-ST Elevated Myocardial Infarction - diagnostic imaging Non-ST Elevated Myocardial Infarction - mortality Non-ST Elevated Myocardial Infarction - therapy Odds Ratio percutaneous coronary intervention Percutaneous Coronary Intervention - adverse effects Percutaneous Coronary Intervention - mortality Percutaneous Coronary Intervention - utilization Retrospective Studies Risk Factors Sex Factors Treatment Outcome Victoria - epidemiology women Young Adult |
| title | Impact of comorbidities and gender on the use of coronary interventions in patients with high-risk non-ST-segment elevation acute coronary syndrome |
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