Department of Endocrinology, Center for Endocrinology Diabetes Arthritis & Rheumatism (CEDAR) Superspeciality Healthcare, Dwarka, New Delhi, India.
Department of Cardiology, Himachal Heart Institute, Mandi, Himachal Pradesh, India.
Indian Heart J. 2024 Sep-Oct;76(5):333-341. doi: 10.1016/j.ihj.2024.10.002. Epub 2024 Oct 9.
Gender differences in acute coronary syndrome (ACS) outcomes have been noted in global data, which however did not analyse Indian data. No prior systematic review and meta-analysis (SRM) has addressed this important aspect of gender bias in Indian women with ACS. Hence this SRM aimed to address this knowledge gap.
Electronic databases were searched for studies in ACS comparing cardiovascular disease presentation, treatment received and outcomes in women and men from India. Primary outcomes were to evaluate gender-differences in 30-day death and major adverse cardiovascular events (MACE). Secondary outcomes were to evaluate gender-differences in presentation, management and mortality. The SRM is registered with PROSPERO (CRD42023477286).
From initially screened 3753 articles, data from 9 studies (61,185 patients) were analysed. Women with ACS had higher prevalence of diabetes [Odds ratio (OR) 1.65(95%CI:1.33-2.04); p < 0.001; I = 95 %] and hypertension [OR2.06(95%CI:1.88-2.25); p < 0.001; I = 42 %]. Smoking was significantly lower in women [OR 0.05(95%CI:0.03-0.07); p < 0.001; I = 87 %]. Non-ST elevation myocardial infarction (NSTEMI) was significantly higher in women [OR 1.92(95%CI:1.66-2.21); p < 0.001; I = 0 %]. Diagnostic angiography [OR 0.64(95%CI:0.56-0.74); p < 0.001; I = 46 %] and percutaneous coronary interventions [OR0.71(95%CI:0.55-0.92); p = 0.01; I = 92 %] were significantly lower in women. Women had significantly higher 30-day mortality [Hazard ratio (HR)2.26(95%CI:2.01-2.55); p < 0.001; I = 6 %], 1-year mortality [HR2.41(95%CI:1.89-3.07); p < 0.001; I = 53 %], in-hospital death [HR1.88(95%CI:1.19-2.96); p = 0.007; I = 92 %], stroke [HR 1.84 (95%CI:1.34-2.52); p < 0.001; I = 0 %] and MACE outcomes [OR 2.05 (95%CI:1.78-2.35); p < 0.001]. Use of aspirin, clopidogrel, beta-blockers and nitrates were significantly lower in women.
Our study highlights worse outcomes in Indian women with ACS. Higher burden of diabetes and hypertension, decreased used of PCI and lesser aggressive pharmacotherapy may be some of the contributing factors.
全球数据显示，急性冠状动脉综合征（ACS）的结局存在性别差异，但这些数据并未分析印度数据。以前没有系统评价和荟萃分析（SRM）来解决印度 ACS 女性中这种性别偏见的重要方面。因此，本 SRM 旨在填补这一知识空白。
检索电子数据库，以比较来自印度的比较心血管疾病表现、接受的治疗和结局的 ACS 研究。主要结局是评估 30 天内死亡和主要不良心血管事件（MACE）的性别差异。次要结局是评估表现、管理和死亡率的性别差异。本 SRM 已在 PROSPERO（CRD42023477286）中注册。
最初筛选出 3753 篇文章后，分析了 9 项研究（61185 名患者）的数据。ACS 女性患者糖尿病患病率较高[优势比（OR）1.65（95%CI：1.33-2.04）；p<0.001；I=95%]和高血压[OR2.06（95%CI：1.88-2.25）；p<0.001；I=42%]。女性吸烟明显减少[OR 0.05（95%CI：0.03-0.07）；p<0.001；I=87%]。非 ST 段抬高心肌梗死（NSTEMI）在女性中明显较高[OR 1.92（95%CI：1.66-2.21）；p<0.001；I=0%]。诊断性血管造影术[OR 0.64（95%CI：0.56-0.74）；p<0.001；I=46%]和经皮冠状动脉介入治疗[OR0.71（95%CI：0.55-0.92）；p=0.01；I=92%]在女性中明显较低。女性 30 天死亡率[风险比（HR）2.26（95%CI：2.01-2.55）；p<0.001；I=6%]、1 年死亡率[HR2.41（95%CI：1.89-3.07）；p<0.001；I=53%]、住院期间死亡率[HR1.88（95%CI：1.19-2.96）；p=0.007；I=92%]、中风[HR 1.84（95%CI：1.34-2.52）；p<0.001]和 MACE 结局[OR 2.05（95%CI：1.78-2.35）；p<0.001]明显较高。女性阿司匹林、氯吡格雷、β受体阻滞剂和硝酸盐的使用率明显较低。
我们的研究强调了印度 ACS 女性的结局较差。糖尿病和高血压负担较高、经皮冠状动脉介入治疗使用率降低以及药物治疗不那么积极可能是一些促成因素。
