Women, Not Treated Aggressively for Acute Coronary Syndrome

Another study has confirmed that gender still influences the recommendation of invasive procedures for the patients hospitalized for acute coronary syndrome: women are less likely to receive invasive treatments, such as coronary angioplasty, as compared to men.

Dr. Sonia S. Anand, Ph.D., of McMaster University in Hamilton, Ontario and her team found that, although this gender imbalance did not influence death rates, women had an increased rate of re-hospitalization for chest pain and refractory ischemia.

The study is a post-hoc analysis of the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial and will be published in the November 15 issue of the Journal of the American College of Cardiology. 4,836 women and 7,726 men from 28 countries participated in the CURE trial. They were hospitalized for acute coronary syndrome between December 1998 and December 2000. All patients were followed up at discharge, after 1 month and at a 3 months interval for the following 9 months.

The study authors stratified the patients according to their risk status and examined the relationship between gender and the procedures used. The outcomes were also adjusted for age, diabetes, smoking habits and cardiovascular disease history.

The results indicated that women underwent fewer invasive procedures - angiography, angioplasty, coronary bypass grafting as compared to men (47.6% vs. 60.5%).

A lower incidence of cardiovascular deaths was found in women as compared to men, as well as a lower incidence of myocardial infarction and stroke. However, more women than men tended to develop refractory ischemia and to be hospitalized for chest pain (23.9% vs. 15.3%).

An explanation suggested by Dr. Anand for these gender differences in treatment is that medical schools used to teach that women were at lesser risk of cardiovascular disease than men. Some data suggested that more women than men simply chose not to have these procedures. Another explanation would be that the chest pain symptoms in women are different than men's chest pains, so they are not so easily recognized by physicians as symptoms indicating the need for invasive procedures.

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