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Sex differences in the management of patients with suspected acute coronary syndrome in China

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Abstract

Few studies have assessed sex differences in the management of suspected acute coronary syndrome (ACS). We aimed to compare the evaluation, treatment, and outcomes between males and females with suspected ACS in the emergency department. Data were obtained from a prospective registry of acute chest pain involving 21 emergency departments in Shandong Province, China. The primary endpoint was 30-day major adverse cardiac events (MACEs). Overlap propensity score weighting was used to address potential confounding. A total of 8046 patients were analysed (42.8% female). Overlap-weighted analysis showed no significant association of female sex with 30-day MACEs (odds ratio, 0.91; 95% CI 0.75 to 1.11; P = 0.363). Secondary analyses found that women were less likely to be identified as high risk at first presentation (odds ratio, 0.86; 95% CI 0.78 to 0.94; P < 0.001). In the emergency department, women were less likely to undergo antiplatelet therapy (odds ratio, 0.87; 95% CI 0.79 to 0.96; P = 0.004) or coronary angiography (odds ratio, 0.78; 95% CI, 0.69 to 0.88; P < 0.001). Women had a longer length of stay in the emergency department and were less likely to be admitted to a ward at disposition. These sex differences existed only in the non-ST-elevation subgroup and were independent of risk stratification. Women with non-ST-elevation chest pain in China received suboptimal treatment in the emergency department. However, their clinical outcomes were not significantly different from those of men. Further studies are needed to determine the causes and impacts of these sex differences.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thank all participating hospitals for their contributions to the EMPACT registry.

Funding

Study was supported by the National Key R&D Program of China (2020YFC1512700, 2020YFC1512705, 2020YFC1512703, 2022YFC0868600), National Science & Technology Fundamental Resources Investigation Project (2018FY100600, 2018FY100602), Key R&D Program of Shandong Province (2021ZLGX02, 2021SFGC0503), Taishan Pandeng Scholar Program of Shandong Province (tspd20181220), The Interdisciplinary Young Researcher Groups Program of Shandong University (2020QNQT004), Youth Top-Talent Project of National Ten Thousand Talents Plan and Qilu Young Scholar Program, Shandong Provincial Natural Science Foundation (ZR2017PH070).

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Authors and Affiliations

  1. Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China

    Kai Cheng, Jiali Wang, Wen Zheng, Shuo Wu, Jiaqi Zheng, Wentao Sang, Jingjing Ma, Jiaojiao Pang, Chang Pan, Guangmei Wang, Yuguo Chen & Feng Xu

  2. Shandong Provincial Clinical Research Centre for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Centre, Qilu Hospital of Shandong University, Jinan, China

    Kai Cheng, Jiali Wang, Wen Zheng, Shuo Wu, Jiaqi Zheng, Wentao Sang, Jingjing Ma, Jiaojiao Pang, Chang Pan, Guangmei Wang, Yuguo Chen & Feng Xu

  3. Shandong Key Laboratory: Magnetic Field-Free Medicine and Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan, China

    Kai Cheng, Jiali Wang, Wen Zheng, Shuo Wu, Jiaqi Zheng, Wentao Sang, Jingjing Ma, Jiaojiao Pang, Chang Pan, Guangmei Wang, Yuguo Chen & Feng Xu

  4. NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, China

    Kai Cheng, Jiali Wang, Wen Zheng, Shuo Wu, Jiaqi Zheng, Wentao Sang, Jingjing Ma, Jiaojiao Pang, Chang Pan, Guangmei Wang, Yuguo Chen & Feng Xu

  5. Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China

    Yangfeng Wu

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Contributions

YC, FX, and JW had the conception and designed the study. KC, WZ, WS, JM, JP, and CP did the literature search. KC, WZ, JZ, JM, JP, CP, and GW provided critical input to the data collection and interpretation. KC and SW did the statistical analysis. KC drafted the manuscript. YC, FX, JW, and YW reviewed the manuscript. All authors revised the manuscript critically and approved the final version. FX takes responsibility for the integrity of the work as a whole from inception to published article.

Corresponding authors

Correspondence to Yangfeng Wu, Yuguo Chen or Feng Xu.

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The authors declare that they have no conflict of interest.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the ethics committee of Qilu Hospital of Shandong University.

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Our work does not involve any violation of human and animal rights.

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Informed consent was obtained from all individual participants included in the study.

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Cheng, K., Wang, J., Zheng, W. et al. Sex differences in the management of patients with suspected acute coronary syndrome in China. Intern Emerg Med (2023). https://doi.org/10.1007/s11739-023-03494-3

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