Abstract
BACKGROUND: Acute coronary syndrome (ACS) presents with significant sex-related differences globally, yet research within Yemen remains limited. This study investigates these differences in the clinical presentation, management, and outcomes of Yemeni patients with ACS. METHODS: A retrospective cohort study was conducted at six tertiary care centers, including 1,743 patients (1,379 men and 364 women) hospitalized with ACS between January 2020 and December 2023. RESULTS: On average, women were generally older than men (59.4 ± 11.7 vs. 57.9 ± 12.7 years, P = 0.031) and more frequently diagnosed with non-ST elevation ACS (35.2% vs. 28.9%, P = 0.021). Women also exhibited higher rates of traditional cardiovascular risk factors, including diabetes mellitus (31.9% vs. 20.8%, P < 0.001) and hypertension (44.5% vs. 32.0%, P < 0.001), but had a lower prevalence of atrial fibrillation (0.8% vs. 2.5%, P = 0.033) and less likely to engage in ACS lifestyle risk behaviors like smoking (31.0% vs. 83.0%, P < 0.001) and khat chewing (53.3% vs. 83.7%, P < 0.001). Women were less likely to receive coronary angiography (47.5% vs. 61.3%, P < 0.001) or percutaneous coronary intervention (33.8% vs. 46.6%, P < 0.001) and were discharged with fewer guideline-recommended therapies for secondary prevention. Women experienced worse in-hospital outcomes, with a significantly higher in-hospital mortality rate (12.6% vs. 7.6%, P = 0.002), especially among those with ST-elevation myocardial infarction (STEMI), which remained significant even after adjustment for all clinical confounding factors (adjusted odds ratio, 1.80; 95% CI, 1.16-2.78, P = 0.008). However, the one-year mortality rate showed no significant difference between genders. CONCLUSION: Yemeni women with ACS experience disparities in treatment and worse in-hospital outcomes, especially in STEMI cases. Addressing gender biases through public health education, healthcare provider training, and infrastructure improvements is essential to improving outcomes.