1. Systematic Review and Meta-analyses Investigating Whether Risk Stratification Explains Lower Rates of Coronary Angiography Among Women With NonYST-Segment Elevation Acute Coronary Syndrome.
- Author
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Worrall-Carter, Linda, McEvedy, Samantha, Kuhn, Lisa, Scruth, Elizabeth, MacIsaac, Andrew, and Rahman, Muhammad Aziz
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ELECTROCARDIOGRAPHY ,MEDICAL information storage & retrieval systems ,MEDLINE ,META-analysis ,ONLINE information services ,RISK assessment ,SEX distribution ,SYSTEMATIC reviews ,ACUTE coronary syndrome ,DESCRIPTIVE statistics ,CORONARY angiography - Abstract
Background: Guidelines recommend that all nonYST-segment elevation acute coronary syndrome (NSTEACS) patients with high-risk features receive a coronary angiogram. We hypothesised that the widely reported gender disparity in the use of angiography might be the result of women more frequently being stratified into the lower-risk category. Objectives: The aim of the study was to review studies reporting risk stratification of NSTEACS patients by gender, compare risk profiles, and assess impact on use of coronary angiography. Methods: PubMed, Scopus, and EMBASE databases were searched on June 17, 2014, using MeSH terms/subheadings and/or keywords with no further limits. The search revealed 1230 articles, of which 25 met our objective. Results: Among the 28 risk-stratified populations described in the 25 articles, women were more likely to be stratified as high-risk in 13 studies; men were more likely to be stratified as high-risk in 3 studies. After meta-analyses, women had a 23% higher odds of being stratified as high-risk than did men (P = .001). Lower-risk patients were more likely to receive an angiogram in 15 study populations. Conclusions: Contrary to our hypothesis, this review showed that women with NSTEACS are more likely than men to be considered high-risk when stratified using a range of risk assessment methods. Lower rates of angiography in women form part of a broader treatment-risk paradox, which may involve gender bias in the selection of patients for invasive therapy. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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