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Clinical characteristics and treatment patterns of acute coronary syndrome in a predominantly African-descent population

Trecia McFarlane, Judith La Rosa, Luther Clark, Clinton Brown and Samy I McFarlane

Background: Acute coronary syndrome is the leading cause of morbidity and mortality regardless of race or gender. Although multicenter trials have provided information on gender differences and racial disparities in access to healthcare and application of treatment guidelines, very few data are available that assess gender differences in clinical characteristics, treatment trajectory and the severity of coronary artery obstruction in predominantly African-descent populations. Methods: Using the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association guidelines (CRUSADE) qualitative initiative, a retrospective chart review was conducted in 198 consecutive patients admitted to the SUNY Downstate University Hospital with the diagnosis of acute coronary syndrome from September 1 2003 to August 31 2004. Sociodemographics, clinical characteristics and treatment patterns for men and women were analyzed. Results: Most patients (79.3%) were of African descent. Of the 198 patients in the cohort hospitalized for ACS, 64% were women. Women were more likely to be obese with a body mass index of 30 kg/m² or less (54 vs. 45% in men; p < 0.01). The prevalence of coronary artery disease risk factors was similar in both sexes, except for insulin-dependent diabetes mellitus, which was noted more in women (54.3 vs. 40.9%; p = 0.033) and cigarette smoking, which was noted more in men (22.5 vs. 9.4%; p = 0.018). In the first 24 h of presentation, men were twice as likely to receive intravenous heparin (23.9 vs. 11% in women; p = 0.024). Statin administration was more likely to be used in women (18.1 vs. 7% in men; p = 0.035). Although not statistically significant, men were more likely to be referred for cardiac catheterization (73.2 vs. 66.1% in women; p = ns). There was no gender difference in the severity of coronary artery disease obstruction (stenosis ≥ 50%) as assessed by coronary catheterization (69.8 vs. 66.6%; p = ns, for men and women, respectively). Conclusion: Gender differences existed in the clinical characteristics and treatment patterns of acute coronary syndrome. However, there was no difference in the severity of coronary artery disease obstruction between men and women. Specific information on cultural attitudes and beliefs that might have influenced the presentation and treatment decision, should be examined in a prospective study.