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Multicenter Study
. 2013 Apr 24;8(4):e62061.
doi: 10.1371/journal.pone.0062061. Print 2013.

Association between gender, process of care measures, and outcomes in ACS in India: results from the detection and management of coronary heart disease (DEMAT) registry

Neha J Pagidipati  1 , Mark D Huffman, Panniyammakal Jeemon, Rajeev Gupta, Prakash Negi, Thannikot M Jaison, Satyavan Sharma, Nakul Sinha, Padinhare Mohanan, B G Muralidhara, Sasidharan Bijulal, Sivasubramonian Sivasankaran, Vijay K Puri, Jacob Jose, K Srinath Reddy, Dorairaj Prabhakaran
Affiliations
Multicenter Study

Association between gender, process of care measures, and outcomes in ACS in India: results from the detection and management of coronary heart disease (DEMAT) registry

Neha J Pagidipati et al. PLoS One. .

Abstract

Background: Studies from high-income countries have shown that women receive less aggressive diagnostics and treatment than men in acute coronary syndromes (ACS), though their short-term mortality does not appear to differ from men. Data on gender differences in ACS presentation, management, and outcomes are sparse in India.

Methods and results: The Detection and Management of Coronary Heart Disease (DEMAT) Registry collected data from 1,565 suspected ACS patients (334 women; 1,231 men) from ten tertiary care centers throughout India between 2007-2008. We evaluated gender differences in presentation, in-hospital and discharge management, and 30-day death and major adverse cardiovascular event (MACE; death, re-hospitalization, and cardiac arrest) rates. Women were less likely to present with STEMI than men (38% vs. 55%, p<0.001). Overall inpatient diagnostics and treatment patterns were similar between men and women after adjustment for potential confounders. Optimal discharge management with aspirin, clopidogrel, beta-blockers, and statin therapy was lower for women than men, (58% vs. 65%, p = 0.03), but these differences were attenuated after adjustment (OR = 0.86 (0.62, 1.19)). Neither the outcome of 30-day mortality (OR = 1.40 (0.62, 3.16)) nor MACE (OR = 1.00 (0.67, 1.48)) differed significantly between men and women after adjustment.

Conclusions: ACS in-hospital management, discharge management, and 30-day outcomes did not significantly differ between genders in the DEMAT registry, though consistently higher treatment rates and lower event rates in men compared to women were seen. These findings underscore the importance of further investigation of gender differences in cardiovascular care in India.

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Conflict of interest statement

Competing Interests: The authors confirm that funding for the DEMAT registry was provided by Merck Sharpe & Dohme (MSD), India. This does not alter their adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Flowchart of participants in DEMAT study.
Figure 2
Figure 2. Association between gender and in-hospital management (OR 95% CI), after adjustment for age, institution, education, history of smoking, diabetes, hypertension, hyperlipidemia; history of coronary heart disease, stroke, or heart failure; history of aspirin, clopidogrel, beta-blocker, statin, ACE inhibitor or ARB; presenting ST segment elevation myocardial infarction; and prior angiography.
Optimal care for in-hospital management includes administration of aspirin, clopidogrel, beta-blocker, statin, and unfractionated or low-molecular weight heparin. (UFH = unfractionated heparin; LMWH = low molecular weight heparin; GPIIb/IIIa = glycoprotein IIb/IIIa inhibitor; PCI = percutaneous coronary intervention; CABG = coronary artery bypass graft surgery).
Figure 3
Figure 3. Association between gender and discharge medications (OR 95% CI), after adjustment for age, institution, education, history of smoking, diabetes, hypertension, hyperlipidemia; history of coronary heart disease, stroke, or heart failure; history of aspirin, clopidogrel, beta-blocker, statin, ACE inhibitor or ARB; presenting ST segment elevation myocardial infarction; and prior angiography.
Optimal care for discharge management includes administration of aspirin, clopidogrel, beta-blocker, and statin. (UFH = unfractionated heparin; LMWH = low molecular weight heparin; GPIIb/IIIa = glycoprotein IIb/IIIa inhibitor; PCI = percutaneous coronary intervention; CABG = coronary artery bypass graft surgery; ARB = angiotensin receptor blocker).
See this image and copyright information in PMC

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