Systematic review and meta-analyses investigating whether risk stratification explains lower rates of coronary angiography among women with non-ST-Segment elevation acute coronary syndrome
Journal article
Worrall-Carter, Linda, McEvedy, Sam, Kuhn, Lisa, Scruth, Elizabeth, MacIsaac, Andrew and Rahman, Aziz. (2017). Systematic review and meta-analyses investigating whether risk stratification explains lower rates of coronary angiography among women with non-ST-Segment elevation acute coronary syndrome. Journal of Cardiovascular Nursing. 32(2), pp. 112 - 124. https://doi.org/10.1097/JCN.0000000000000300
Authors | Worrall-Carter, Linda, McEvedy, Sam, Kuhn, Lisa, Scruth, Elizabeth, MacIsaac, Andrew and Rahman, Aziz |
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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 key words 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. |
Keywords | acute coronary syndrome; angiogram; meta-analyses; risk stratification; women |
Year | 2017 |
Journal | Journal of Cardiovascular Nursing |
Journal citation | 32 (2), pp. 112 - 124 |
Publisher | Lippincott Williams & Wilkins |
ISSN | 0889-4655 |
Digital Object Identifier (DOI) | https://doi.org/10.1097/JCN.0000000000000300 |
Scopus EID | 2-s2.0-84946599895 |
Page range | 112 - 124 |
Research Group | Mary MacKillop Institute for Health Research |
Publisher's version | File Access Level Controlled |
Place of publication | United States |
Editors | B. Riegel and D. K. Moser |
https://acuresearchbank.acu.edu.au/item/88wz3/systematic-review-and-meta-analyses-investigating-whether-risk-stratification-explains-lower-rates-of-coronary-angiography-among-women-with-non-st-segment-elevation-acute-coronary-syndrome
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