Al-Assadi Muammar Yahiya, Aljaber Nouradden Noman, Al-Habeet Abdulhafeedh, Al Nono Osama, Al-Motarreb Ahmed
Department of Cardiology, Faculty of Medicine, Sana'a university, Sana'a, Yemen.
Department of Epidemiology and Biostatistics, Faculty of Medical Sciences, Al-Razi University, Sana'a, Yemen.
Front Cardiovasc Med. 2025 Jun 3;12:1481917. doi: 10.3389/fcvm.2025.1481917. eCollection 2025.
Acute coronary syndrome (ACS) presents with significant sex-related differences globally, yet research within Yemen remains limited. This study investigates these differences in the clinical presentation, management, and outcomes of Yemeni patients with ACS.
A retrospective cohort study was conducted at six tertiary care centers, including 1,743 patients (1,379 men and 364 women) hospitalized with ACS between January 2020 and December 2023.
On average, women were generally older than men (59.4 ± 11.7 vs. 57.9 ± 12.7 years, = 0.031) and more frequently diagnosed with non-ST elevation ACS (35.2% vs. 28.9%, = 0.021). Women also exhibited higher rates of traditional cardiovascular risk factors, including diabetes mellitus (31.9% vs. 20.8%, < 0.001) and hypertension (44.5% vs. 32.0%, < 0.001), but had a lower prevalence of atrial fibrillation (0.8% vs. 2.5%, = 0.033) and less likely to engage in ACS lifestyle risk behaviors like smoking (31.0% vs. 83.0%, < 0.001) and khat chewing (53.3% vs. 83.7%, < 0.001). Women were less likely to receive coronary angiography (47.5% vs. 61.3%, < 0.001) or percutaneous coronary intervention (33.8% vs. 46.6%, < 0.001) and were discharged with fewer guideline-recommended therapies for secondary prevention. Women experienced worse in-hospital outcomes, with a significantly higher in-hospital mortality rate (12.6% vs. 7.6%, = 0.002), especially among those with ST-elevation myocardial infarction (STEMI), which remained significant even after adjustment for all clinical confounding factors (adjusted odds ratio, 1.80; 95% CI, 1.16-2.78, = 0.008). However, the one-year mortality rate showed no significant difference between genders.
Yemeni women with ACS experience disparities in treatment and worse in-hospital outcomes, especially in STEMI cases. Addressing gender biases through public health education, healthcare provider training, and infrastructure improvements is essential to improving outcomes.
急性冠状动脉综合征（ACS）在全球范围内存在显著的性别差异，但也门国内的相关研究仍然有限。本研究调查也门ACS患者在临床表现、治疗及预后方面的这些差异。
在六个三级护理中心进行了一项回顾性队列研究，纳入了2020年1月至2023年12月期间因ACS住院的1743例患者（1379例男性和364例女性）。
平均而言，女性总体上比男性年龄更大（59.4±11.7岁 vs. 57.9±12.7岁，P = 0.031），更常被诊断为非ST段抬高型ACS（35.2% vs. 28.9%，P = 0.021）。女性还表现出更高的传统心血管危险因素发生率，包括糖尿病（31.9% vs. 20.8%，P<0.001）和高血压（44.5% vs. 32.0%，P<0.001），但房颤患病率较低（0.8% vs. 2.5%，P = 0.033），且较少参与吸烟（31.0% vs. 83.0%，P<0.001）和咀嚼恰特草（53.3% vs. 83.7%，P<0.001）等ACS生活方式风险行为。女性接受冠状动脉造影（47.5% vs. 61.3%，P<0.001）或经皮冠状动脉介入治疗（33.8% vs. 46.6%，P<0.001）的可能性较小，出院时接受二级预防的指南推荐治疗也较少。女性住院结局较差，住院死亡率显著更高（12.6% vs. 7.6%，P = 0.002），尤其是ST段抬高型心肌梗死（STEMI）患者，即使在调整所有临床混杂因素后仍具有显著性差异（调整后的比值比为1.80；95%置信区间为1.16 - 2.78，P = 0.008）。然而，一年死亡率在性别之间无显著差异。
也门ACS女性患者在治疗方面存在差异且住院结局较差，尤其是在STEMI病例中。通过公共卫生教育、医疗服务提供者培训和基础设施改善来消除性别偏见对于改善结局至关重要。
