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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

Background 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. Objectives To study the trends in sex and gender differences in ACS usin...

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Main Authors: Lee, Chuey Yan, Liu, Kien Ting, Lu, Hou Tee, Ali, Rosli Mohd, Fong, Alan Yean Yip, Ahmad, Wan Azman Wan
Format: Article
Published: Public Library of Science 2021
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R Medicine (General)
Online Access:http://eprints.um.edu.my/28532/
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spelling my.um.eprints.285322022-08-15T07:53:23Z http://eprints.um.edu.my/28532/ 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 Lee, Chuey Yan Liu, Kien Ting Lu, Hou Tee Ali, Rosli Mohd Fong, Alan Yean Yip Ahmad, Wan Azman Wan R Medicine (General) Background 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. Objectives To study the trends in sex and gender differences in ACS using the Malaysian NCVD-ACS Registry. Methods Data from 24 hospitals involving 35,232 ACS patients (79.44% men and 20.56% women) from 1(st.) Jan 2012 to 31(st.) 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). Results 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. Conclusion 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. Public Library of Science 2021-02-08 Article PeerReviewed Lee, Chuey Yan and Liu, Kien Ting and Lu, Hou Tee and Ali, Rosli Mohd and Fong, Alan Yean Yip and Ahmad, Wan Azman Wan (2021) 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. PLoS ONE, 16 (2). ISSN 1932-6203, DOI https://doi.org/10.1371/journal.pone.0246474 <https://doi.org/10.1371/journal.pone.0246474>. 10.1371/journal.pone.0246474
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine (General)
spellingShingle R Medicine (General)
Lee, Chuey Yan
Liu, Kien Ting
Lu, Hou Tee
Ali, Rosli Mohd
Fong, Alan Yean Yip
Ahmad, Wan Azman Wan
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
description Background 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. Objectives To study the trends in sex and gender differences in ACS using the Malaysian NCVD-ACS Registry. Methods Data from 24 hospitals involving 35,232 ACS patients (79.44% men and 20.56% women) from 1(st.) Jan 2012 to 31(st.) 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). Results 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. Conclusion 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.
format Article
author Lee, Chuey Yan
Liu, Kien Ting
Lu, Hou Tee
Ali, Rosli Mohd
Fong, Alan Yean Yip
Ahmad, Wan Azman Wan
author_facet Lee, Chuey Yan
Liu, Kien Ting
Lu, Hou Tee
Ali, Rosli Mohd
Fong, Alan Yean Yip
Ahmad, Wan Azman Wan
author_sort Lee, Chuey Yan
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_short 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_full 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_fullStr 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_full_unstemmed 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_sort 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
publisher Public Library of Science
publishDate 2021
url http://eprints.um.edu.my/28532/
_version_ 1744649123955474432
score 13.211869

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