Background: The incidence of acute coronary syndrome is reported to be higher
for males than females, yet clinical outcomes following acute myocardial infarction are
worse among females. Information about acute coronary syndrome outcomes is obtained
from randomised and cohort data. However, randomised controlled trials which are designed
to evaluate the efficacy of clinical interventions often have limited external validity, and
observational studies which draw inferences from the effect of an exposure whilst being
more generalizable are limited by confounding. Methods: We undertook a structured literature
review of research manuscripts published between 2000 and 2015 to examine whether
reported sex-dependent outcomes following acute coronary syndrome differed between
randomised control trials and observational registries. Results: Of 56 manuscripts, we found
consistency between the two types of study designs – each type of study describing worse
clinical outcomes for females with acute coronary syndrome. We also found a reduction in
the use of guideline recommended therapy in females. Conclusion: Further research is needed to understand at a
mechanistic and health services level why such a discrepancy in clinical outcomes exists.
Keywords: Acute coronary syndrome, sex outcomes, trials, registries.
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