Sustained Sex-based Treatment Differences in Acute Coronary Syndrome Care: Insights from the American Heart Association Get With the Guidelines Coronary Artery Disease Registry.

Sustained Sex-based Treatment Differences in Acute Coronary Syndrome Care: Insights from the American Heart Association Get With the Guidelines Coronary Artery Disease Registry.
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Udell JA, Fonarow GC, Maddox TM, Cannon CP, Peacock WF, Laskey WK, Grau-Sepulveda MV, Smith EE, Hernandez AF, Peterson ED, Bhatt DL, ,


Udell JA, Fonarow GC, Maddox TM, Cannon CP, Peacock WF, Laskey WK, Grau-Sepulveda MV, Smith EE, Hernandez AF, Peterson ED, Bhatt DL, , (click to view)

Udell JA, Fonarow GC, Maddox TM, Cannon CP, Peacock WF, Laskey WK, Grau-Sepulveda MV, Smith EE, Hernandez AF, Peterson ED, Bhatt DL, ,

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Clinical cardiology 2018 03 09() doi 10.1002/clc.22938
Abstract
BACKGROUND
Sex-based differences in acute coronary syndrome (ACS) mortality may attenuate with age due to better symptom recognition and prompt care. Hypothesis Age is a modifier of temporal trends in sex-based differences in ACS care.

METHODS
Among 104,817 eligible patients with ACS enrolled in the AHA GWTG-CAD registry between 2003-2008, care and in-hospital mortality were evaluated stratified by sex and age (<65 years and ≥65 years). Temporal trends within sex and age groups were assessed for two care processes: the percentage of patients with ST-elevation MI (STEMI) presenting to PCI capable hospitals with a door-to-balloon time ≤ 90 minutes (DTB90) and the proportion of eligible patients with ACS treated with aspirin within 24 hours of presentation. RESULTS
After adjustment for clinical risk factors, sociodemographic and hospital characteristics, 2276 (51.7%) women and 6276 (56.9%) men with STEMI were treated with a DTB90 (adjusted OR 0.85, 95% CI 0.80-0.91, P<0.0001 for women vs. men). Time trend analysis showed an absolute increase ranging from 24-35% in DTB90 rates among both men and women (P-trend <0.0001 for each group) with consistent differences over time across the four age/sex groups (3-way P-interaction=0.93). Despite a high rate of aspirin use at baseline (87-91%), there was a 9-11% absolute increase in aspirin use over time, also with consistent differences across the four age/sex groups (all P-interaction ≥0.15). CONCLUSION
There were substantial gains in ACS performance measures over six years of study of generally similar magnitude across sex and age groups; areas for improvement remain particularly among younger women.

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