• James R Langabeer, Tiffany Champagne-Langabeer, Raymond Fowler, and Timothy Henry.
• University of Texas Health Science Center, Houston, TX, United States. Electronic address: James.R.Langabeer@uth.tmc.edu.
• Am J Emerg Med. 2019 Feb 1; 37 (2): 179-182.

BackgroundIt is known that women generally have worse mortality outcomes than men with regards to ST-segment elevation myocardial infarction. However, less is known about contemporary gender differences in non-STEMI acute coronary syndrome, particularly those presenting to emergency departments within a regionalized system of care with standardized protocols.MethodsRetrospective registry data from 2010 to 2016 were examined from the North Texas Mission: Lifeline system of care, representing 33 hospitals around the Dallas Texas metropolitan area. We explored gender-based differences using multivariate logistic regression model, controlling for patient's age, baseline condition, and hospital factors.ResultsThere were 16,861 patients who presented directly to emergency departments with NSTEMI, and 6513 (38.6%) were women. At baseline, women were older (68.04 vs. 63.7 years, p < 0.001) and presented with history of prior cardiovascular disease more often than men. Women had higher unadjusted in-hospital mortality rates than men (4.8% vs. 3.9%, p < 0.001), which persisted after controlling for patient age, comorbidities, and hospital factors. Women also had 23 min longer ED lengths of stay (p < 0.001) and were much less likely to receive an early invasive strategy (diagnostic coronary angiography within 24 h of arrival) than men (47.0% vs 54.4%, p < 0.001).ConclusionEmergency department NSTEMI protocols should consider potential gender disparities that exist for women. Overall, women had worse outcomes, which persist even in an urban system of care with standardized protocols.Copyright © 2018 Elsevier Inc. All rights reserved.

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