Gender gap extends to treatment for acute coronary syndrome

Younger women with acute coronary syndrome may not receive care as quickly as men, a study published online March 17 in the Canadian Medical Association Journal found. The study also found that women were less likely than men to get certain treatments for ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation MI (NSTEMI) or unstable angina.


Roxanne Pelletier, PhD, of McGill University Health Centre in Montreal, and co-investigators used data from 1,123 participants enrolled in the GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond – Premature Acute Coronary Syndrome (GENESIS-PRAXY) study between 2009 and 2013. GENESIS-PRAXY investigated factors related to sex and gender that may play a role in heart disease. Participants were between 18 and 55 and were hospitalized with acute coronary syndrome. The outcomes were door-to-electrocardiography (ECG) time, door-to-needle time, door-to-balloon time and proportions of patients undergoing cardiac catheterization, reperfusion or nonprimary PCI.

Compared with men, women were less likely to receive an ECG within the recommended time of 10 minutes or less (29 percent vs. 38 percent) or fibrinolysis within the recommended time of 30 minutes or less (32 percent vs. 57 percent). Women with STEMI were less likely than men to undergo PCI or fibrinolysis (83 percent vs. 91 percent), and women with NSTEMI or unstable angina were less likely to undergo nonprimary PCI (48 percent vs. 66 percent).

Clinical factors associated with poorer access to care among women were anxiety, more risk factors and the absence of chest pain. Factors related to sex that were associated with differences in access to care were responsibility for housework (more responsibility for housework was associated with a lower likelihood of certain treatments) and a higher femininity score based on the Bem Sex Role Inventory (a higher score was associated with a lower likelihood of certain treatments).

“These groups of patients presenting to the emergency department with cardiac-like symptoms may need targeting for more effective initial management of acute coronary syndrome,” the authors wrote.