Disparities in the initial approach for men and women with acute coronary syndromes

Cardiovascular disease, particularly coronary artery disease, has emerged as the primary cause of mortality in women across Europe, as highlighted by the Organization for Economic Co-Operation and Development (OECD). While preventive measures are crucial, understanding gender-based differences in treatment approaches could further enhance efforts to reduce mortality.

This study aims to investigate gender disparities in the initial approach to acute coronary syndromes (ACS).

We performed an observational study with retrospective analysis of all patients included between 2002 and 2019 in the Portuguese Registry of Acute Coronary Syndromes (ProACS),a voluntary, observational, prospective, continuous registry of the Portuguese Society of Cardiology and the National Center for Data Collection in Cardiology.

A total of 49,113 patients (34,936 men and 14,177 women) were included. Women with ACS were significantly older than men (72±12 years vs. 64±13years, p<0.001). While chest pain is the predominant symptom in both genders, there was a significant difference between men and women experiencing this symptom (96.8% vs. 94.7%, p<0.001). Women more frequently presented with equivalent symptoms: dyspnea, fatigue, syncope, and other symptoms (see table 1).

When calling 112, women were more frequently than men transported in an ambulance only with paramedics (31.8% vs. 26.5%, p<0.01), and less likely to be transported to the hospital with a medical team ("Viatura Médica de Emergência e Reanimação" - VMER).

Women experienced a longer duration of symptoms until their first medical contact (FMC),and a greater time delay from FMC until needle, balloon or reperfusion (p<0.001, see table 1).

Women more frequently present with equivalent symptoms than men, despite chest pain being the same predominant symptom. This gender-specific clinical presentation affects the timely identification of ischemic symptoms, compromises the fast and safe emergency transport, resulting in an extended time until FMC and significant delays in revascularization for female patients. This delay may consequently elevate the risk of mortality in women.

To address this, increased awareness of ACS and its presentation in women is essential, not only among the general population, but also among triage teams (both pre-hospital and in-hospital) and all health-care providers in the emergency department. These efforts can help reduce the extratime until treatment seen in female patients.

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