Sex differences in care for acute coronary syndrome in patients under 60 years:Primary care presentation, referral patterns, hospitalizations and clinical outcomes

Objectives Acute coronary syndrome (ACS) incidence and mortality rates have risen among women <60 years. This study sought to examine sex differences in healthcare pathways for first-time ACS in young patients, focusing on pre-ACS care, diagnosis and in-hospital management, and post-discharge outcomes. Study design Observational cohort study. Methods This study uses linked data from primary care, hospital records and national mortality datasets to assess ACS care pathways among Dutch patients aged 30-60 years between 2013 and 2022. Continuous variables were compared with Wilcoxon rank-sum tests and categorical variables with Chi-square tests. Multiple testing is addressed by controlling the false discovery rate. Results Women more often had at least one comorbidity (57.6 % vs 51.3 %, p = 0.024) and more primary care consultations in the month preceding ACS (1.37 vs 1.00, p < 0.001). Men were more frequently diagnosed with ST-elevation myocardial infarction (STEMI), while women were more often diagnosed with non-ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA), p < 0.001. In-hospital interventions were similar between sexes for STEMI but were different and less frequently performed in women with NSTEMI (p = 0.001) or UA (p = 0.005) compared with men. Post-discharge, women were less likely to receive antithrombotic (87.7 % vs 91.5 %, p = 0.024) and lipid-lowering therapies (82.6 % vs 88.5 %, p = 0.002). Mortality rates before hospitalization, at 30 days, and at 1 year were comparable between sexes. Conclusions Sex differences exist in healthcare pathways for individuals aged 30-60 years with first-time ACS regarding prevalence of comorbidities, ACS subtype, in-hospital interventions, and post-discharge medication use. However, 30-day and 1-year survival rates after discharge were comparable between women and men.