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The aim of this study was to evaluate the gender differences in baseline characteristics, therapy, and outcomes in patients with acute coronary syndromes in 6 Middle Eastern countries. Over a 6-month period in 2007, 8,169 consecutive patients (74% men, 24% women) presenting with acute coronary syndromes were enrolled in a prospective, multicenter study from 6 adjacent Middle Eastern countries. Women were 9 years older than men and more likely to have diabetes, hypertension, and dyslipidemia. Women were more likely to present with unstable angina and more often had atypical presentations of ST elevation myocardial infarction. Compared to men, women were significantly less treated with beta blockers and antiplatelet therapy, whereas reperfusion therapy was nonsignificantly less used in women. In all patients with acute coronary syndromes, women not only ranked higher on Global Registry of Acute Coronary Events risk score but also had increased in-hospital mortality, 1.75 times that of men. This mortality difference persisted after adjusting for all confounders (odds ratios 1.76, 95% confidence interval 1.1 to 2.8, p0.01). In conclusion, in addition to presentation with higher risk factors, female gender also independently predicted poorer outcomes in patients with ST elevation myocardial infarction.

We used two cross-sectional surveys involving 6356 Omanis aged >or= 20 years to estimate the effect of the 1997 American Diabetes Association (ADA) criteria on the prevalence of diabetes mellitus in Oman and develop a validated optimal fasting plasma glucose (FPG) cut-point which best predicts diabetes diagnosed 2-h post oral glucose tolerance test. Applying the 1997 ADA criteria to Oman would underestimate diabetes by 18%. The sensitivity of the ADA criteria was 68.3% (95% CI 64.0-72.4%) and specificity was 98.6% (95% CI 98.2-98.9%). Receiver-operating characteristic (ROC) curve depicted FPG>5.9 mmol/l to best predict 2-h post-load glucose >or=11.1 mmol/l. The area under the ROC curve was 0.95 (95% CI 0.94-0.95%) with no significant difference between obese and non-obese individuals. This cut-point had a sensitivity of 87.5% (95% CI 84.3-90.3%), specificity of 90.8% (95% CI 89.9-91.7%) and likelihood ratio of 9.5. On validation in an independent population, the sensitivity and specificity of the depicted cut-point remained high 84.2% (95% CI 77.0-89.8%) and 80.2% (95% CI 78.0-82.4%) compared to the ADA values 60.4% and 96.6%, respectively. Our study identified a lower cut-point to diagnose diabetes than that suggested by the 1997 ADA criteria.

Little is known about the effect of female gender on cardiac arrhythmias in patients with acute coronary syndromes (ACS). Accordingly, we sought to assess the effect of gender on the incidence and in-hospital mortality of patients with clinically significant arrhythmias (CSA) in a multicenter