Gender-based outcome differences for emergency department presentation ofnon-STEMI acute coronary syndrome

James R. Langabeer, Tiffany Champagne-Langabeer, Raymond Fowler, Timothy Henry

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: It is known that women generally have worse mortality outcomes than men with regards to ST-segment elevation myocardial infarction. However, less is known about contemporary gender differences in non-STEMI acute coronary syndrome, particularly those presenting to emergency departments within a regionalized system of care with standardized protocols. Methods: Retrospective registry data from 2010 to 2016 were examined from the North Texas Mission: Lifeline system of care, representing 33 hospitals around the Dallas Texas metropolitan area. We explored gender-based differences using multivariate logistic regression model, controlling for patient's age, baseline condition, and hospital factors. Results: There were 16,861 patients who presented directly to emergency departments with NSTEMI, and 6513 (38.6%) were women. At baseline, women were older (68.04 vs. 63.7 years, p < 0.001) and presented with history of prior cardiovascular disease more often than men. Women had higher unadjusted in-hospital mortality rates than men (4.8% vs. 3.9%, p < 0.001), which persisted after controlling for patient age, comorbidities, and hospital factors. Women also had 23 min longer ED lengths of stay (p < 0.001) and were much less likely to receive an early invasive strategy (diagnostic coronary angiography within 24 h of arrival) than men (47.0% vs 54.4%, p < 0.001). Conclusion: Emergency department NSTEMI protocols should consider potential gender disparities that exist for women. Overall, women had worse outcomes, which persist even in an urban system of care with standardized protocols.

Original languageEnglish (US)
JournalAmerican Journal of Emergency Medicine
DOIs
StateAccepted/In press - Jan 1 2018

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Acute Coronary Syndrome
Hospital Emergency Service
Logistic Models
Mortality
Hospital Mortality
ST Elevation Myocardial Infarction
Coronary Angiography
Registries
Comorbidity
Length of Stay
Cardiovascular Diseases

Keywords

  • Mortality
  • Myocardial infarction
  • NSTEMI
  • Outcomes
  • Sex

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Gender-based outcome differences for emergency department presentation ofnon-STEMI acute coronary syndrome. / Langabeer, James R.; Champagne-Langabeer, Tiffany; Fowler, Raymond; Henry, Timothy.

In: American Journal of Emergency Medicine, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background: It is known that women generally have worse mortality outcomes than men with regards to ST-segment elevation myocardial infarction. However, less is known about contemporary gender differences in non-STEMI acute coronary syndrome, particularly those presenting to emergency departments within a regionalized system of care with standardized protocols. Methods: Retrospective registry data from 2010 to 2016 were examined from the North Texas Mission: Lifeline system of care, representing 33 hospitals around the Dallas Texas metropolitan area. We explored gender-based differences using multivariate logistic regression model, controlling for patient's age, baseline condition, and hospital factors. Results: There were 16,861 patients who presented directly to emergency departments with NSTEMI, and 6513 (38.6{\%}) were women. At baseline, women were older (68.04 vs. 63.7 years, p < 0.001) and presented with history of prior cardiovascular disease more often than men. Women had higher unadjusted in-hospital mortality rates than men (4.8{\%} vs. 3.9{\%}, p < 0.001), which persisted after controlling for patient age, comorbidities, and hospital factors. Women also had 23 min longer ED lengths of stay (p < 0.001) and were much less likely to receive an early invasive strategy (diagnostic coronary angiography within 24 h of arrival) than men (47.0{\%} vs 54.4{\%}, p < 0.001). Conclusion: Emergency department NSTEMI protocols should consider potential gender disparities that exist for women. Overall, women had worse outcomes, which persist even in an urban system of care with standardized protocols.",
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