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Impact of comorbidities and gender on the use of coronary interventions in patients with high‐risk non‐ ST ‐segment elevation acute coronary syndrome
Author(s) -
WorrallCarter Linda,
McEvedy Samantha,
Wilson Andrew,
Rahman Muhammad Aziz
Publication year - 2016
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26117
Subject(s) - medicine , acute coronary syndrome , comorbidity , psychological intervention , confounding , st elevation , myocardial infarction , psychiatry
Objectives To determine the impact of gender and comorbidity on use of coronary interventions in patients diagnosed with high‐risk non‐ST‐segment acute coronary syndrome (NSTEACS). Background Guidelines recommend the use of coronary angiography for all patients diagnosed with NSTEACS with high‐risk features, except in the presence of severe comorbidities. However, little is understood about the relationship between gender, comorbidity, and the use of coronary interventions. Methods Retrospective analyses of the Victorian Admitted Episodes Data Set (VAED) including all patients diagnosed with NSTEACS with high‐risk features on their first admission for ACS between June 2007 and July 2009. Hierarchical logistic regression models and correspondence analyses were used to understand the relationship between gender, comorbidities, and the use of coronary interventions. Results Out of 16,771 NSTEACS patients with high‐risk features, 6,338 (38%) were female. Females were older than males (aged ≥75: 62% vs 39%, p < 0.001) and more likely to have multiple comorbidities (≥2: 66% vs 59%, p < 0.001). After adjusting for potential confounders, females were more likely to receive no coronary intervention than males with a similar number of comorbid conditions (no comorbidities: OR 1.62, 95% CI 1.28–2.05; 1 comorbidity: OR 1.67, 95% CI 1.44–1.93; 2 comorbidities: OR 1.93, 95% CI 1.66–2.23; ≥3 comorbidities: OR 1.42, 95% CI 1.27–1.60). Conclusions Lower rates of coronary intervention in females persisted after adjusting for number of comorbidities which suggests that gender may bias decisions regarding referral for coronary intervention in high‐risk NSTEACS independent of other factors. © 2015 Wiley Periodicals, Inc.