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[Gender differences in patients with suspected non-ST-segment elevation acute coronary syndromes. Implications for
Vicent Bodí1, Lorenzo Fácila, Juan Sanchís
1Servei de Cardiologia. Hospital Clínic i Universitari. Universitat de València. España. vicentbodi@hotmail.com
Insights
Men with unstable ischemic heart disease received more invasive care, but this difference wasn't independent of other factors. A chest pain unit protocol improved treatment strategies for acute coronary syndrome.
Area of Science:
- Cardiology
- Clinical Medicine
- Health Services Research
Background:
- Sex differences impact the clinical presentation, prognosis, and treatment of unstable ischemic heart disease.
- Men historically receive more invasive management strategies compared to women.
Purpose of the Study:
- To assess sex differences in the management of acute coronary syndrome without ST-segment elevation.
- To evaluate the impact of a chest pain unit and standardized protocol on invasive treatment strategies.
Main Methods:
- Retrospective analysis of 823 consecutive patients (543 men) with possible acute coronary syndrome without ST-segment elevation.
- Application of a standardized protocol for unstable ischemic heart disease management within a chest pain unit.
Main Results:
- Women presented with a worse baseline clinical profile; men more frequently had positive exercise stress tests.
- Univariate analysis indicated higher rates of angiography and revascularization in men.
- Multivariate analysis did not identify male sex as an independent predictor for more invasive strategies.
Conclusions:
- The implementation of a chest pain unit and a standardized protocol effectively improved case stratification and optimized invasive treatment application.
- Observed sex differences in invasive management may be influenced by factors beyond sex itself, highlighting the importance of standardized protocols.
Abstract:
Sex differences have been observed in the clinical profile, prognosis, and treatment of patients with unstable ischemic heart disease. Men tend to receive more invasive management. We assessed these differences in 823 consecutive patients (543 men) with possible acute coronary syndrome without ST-segment elevation who were seen since our chest pain unit opened. A protocol for the management of unstable ischemic heart disease was followed. Women had a worse baseline clinical profile but men more frequently had a positive exercise stress test. Univariate analysis showed that angiography and revascularization procedures were performed more often in men. However, multivariate analysis did not confirm male sex as an independent predictor of the need for a more invasive strategy. The inauguration of a chest pain unit and application of a protocol for the management of unstable ischemic heart disease has helped to correct case stratification and optimize the application of invasive treatments.