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IMPACT OF GENDER ON OUTCOMES AMONG PATIENTS WITH ACUTE CORONARY SYNDROME UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN SOUTHEAST ASIA
2540 JACC March 21, 2017 Volume 69, Issue 11
Spotlight on Special Topics IMPACT OF GENDER ON OUTCOMES AMONG PATIENTS WITH ACUTE CORONARY SYNDROME UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN SOUTHEAST ASIA Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m. Session Title: Innovations in Advocacy and Patient Centered Care Abstract Category: 42. Spotlight on Special Topics: Education, Innovation, Advocacy, Social Media, Leadership and Practice Management Presentation Number: 1258-441 Authors: Paramaporn Suttirut, Sowitchaya Panthong, Veraprapas Kittipibul, Vorarit Lertsuwunseri, Suphot Srimahachota, Aekarach Ariyachaipanich, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background: There were evidences that women benefit less from medical advancement including treatments of ST-elevation myocardial infarction (STEMI). However, there was limited data of gender inequality in developing countries. The aim of this study was to determine the effect of female gender on mortality rate in patient with STEMI undergoing primary percutaneous coronary intervention (PCI). Methods: We conducted a retrospective study of consecutive patients with diagnosis of STEMI who underwent primary PCI at a tertiary care hospital in Thailand from January 2011 to December 2014. Patient characteristics, treatments and outcomes were gathered. T-test, Chi-square and survival time analysis were used to analyze.
Results: Total of 460 patients (mean age of 59.7 ± 14 years and 24.8% female) were included. Women were significantly older (68.3 ± 14.2 vs 56.9 ± 12.8, p < 0.001) and had more comorbidities include hypertension (74.6% vs 48.6%, p < 0.001), diabetes mellitus (40.3% vs 25.7%, p = 0.003), chronic kidney disease (7.9% vs 3.2%, p = 0.03). There were no significant differences in door-to-balloon time or medical treatment during hospitalization but women were less likely to be prescribed aspirin and statin at hospital discharge (p = 0.43 and 0.02 respectively). The 30-day mortality rate in women (18.4%) was higher than men (8.67%), hazard ratio of 2.3 (95% confident interval (CI) 1.3 - 4.1, p = 0.005). there were also significantly higher 6-month and 1-year mortality rates in women group (p = 0.005 for both). With multivariate logistic regression analysis, we still found that female gender was the independent risk marker for a 30-day mortality (hazard ratio = 2.6, 95% CI 1.3 - 4.7, p = 0.006) when compare to their male counterparts. Conclusions: Even in a developing country such as Thailand, in this single center experience, female gender was independently associated with 30-day mortality in patients with STEMI. This reflects the same disparity in outcomes that was found in western countries.
Spotlight on Special Topics IMPACT OF GENDER ON OUTCOMES AMONG PATIENTS WITH ACUTE CORONARY SYNDROME UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN SOUTHEAST ASIA Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m. Session Title: Innovations in Advocacy and Patient Centered Care Abstract Category: 42. Spotlight on Special Topics: Education, Innovation, Advocacy, Social Media, Leadership and Practice Management Presentation Number: 1258-441 Authors: Paramaporn Suttirut, Sowitchaya Panthong, Veraprapas Kittipibul, Vorarit Lertsuwunseri, Suphot Srimahachota, Aekarach Ariyachaipanich, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background: There were evidences that women benefit less from medical advancement including treatments of ST-elevation myocardial infarction (STEMI). However, there was limited data of gender inequality in developing countries. The aim of this study was to determine the effect of female gender on mortality rate in patient with STEMI undergoing primary percutaneous coronary intervention (PCI). Methods: We conducted a retrospective study of consecutive patients with diagnosis of STEMI who underwent primary PCI at a tertiary care hospital in Thailand from January 2011 to December 2014. Patient characteristics, treatments and outcomes were gathered. T-test, Chi-square and survival time analysis were used to analyze.
Results: Total of 460 patients (mean age of 59.7 ± 14 years and 24.8% female) were included. Women were significantly older (68.3 ± 14.2 vs 56.9 ± 12.8, p < 0.001) and had more comorbidities include hypertension (74.6% vs 48.6%, p < 0.001), diabetes mellitus (40.3% vs 25.7%, p = 0.003), chronic kidney disease (7.9% vs 3.2%, p = 0.03). There were no significant differences in door-to-balloon time or medical treatment during hospitalization but women were less likely to be prescribed aspirin and statin at hospital discharge (p = 0.43 and 0.02 respectively). The 30-day mortality rate in women (18.4%) was higher than men (8.67%), hazard ratio of 2.3 (95% confident interval (CI) 1.3 - 4.1, p = 0.005). there were also significantly higher 6-month and 1-year mortality rates in women group (p = 0.005 for both). With multivariate logistic regression analysis, we still found that female gender was the independent risk marker for a 30-day mortality (hazard ratio = 2.6, 95% CI 1.3 - 4.7, p = 0.006) when compare to their male counterparts. Conclusions: Even in a developing country such as Thailand, in this single center experience, female gender was independently associated with 30-day mortality in patients with STEMI. This reflects the same disparity in outcomes that was found in western countries.