{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:22:41Z","timestamp":1791850961221,"version":"4.3.4"},"reference-count":59,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T00:00:00Z","timestamp":1612742400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health Malaysia, URL:https:\/\/www.moh.gov.my"},{"name":"National Heart Association of Malaysia (NHAM), URL:https:\/\/www.malaysianheart.org\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Sex and gender differences in acute coronary syndrome (ACS) have been well studied in the western population. However, limited studies have examined the trends of these differences in a multi-ethnic Asian population.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Objectives<\/jats:title><jats:p>To study the trends in sex and gender differences in ACS using the Malaysian NCVD-ACS Registry.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Methods<\/jats:title><jats:p>Data from 24 hospitals involving 35,232 ACS patients (79.44% men and 20.56% women) from 1<jats:sup>st.<\/jats:sup>Jan 2012 to 31<jats:sup>st.<\/jats:sup>Dec 2016 were analysed. Data were collected on demographic characteristics, coronary risk factors, anthropometrics, treatments and outcomes. Analyses were done for ACS as a whole and separately for ST-segment elevation myocardial infarction (STEMI), Non-STEMI and unstable angina. These were then compared to published data from March 2006 to February 2010 which included 13,591 ACS patients (75.8% men and 24.2% women).<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Results<\/jats:title><jats:p>Women were older and more likely to have diabetes mellitus, hypertension, dyslipidemia, previous heart failure and renal failure than men. Women remained less likely to receive aspirin, beta-blocker, angiotensin-converting enzyme inhibitor (ACE-I) and statin. Women were less likely to undergo angiography and percutaneous coronary intervention (PCI) despite an overall increase. In the STEMI cohort, despite a marked increase in presentation with Killip class IV, women were less likely to received primary PCI or fibrinolysis and had longer median door-to-needle and door-to-balloon time compared to men, although these had improved. Women had higher unadjusted in-hospital, 30-Day and 1-year mortality rates compared to men for the STEMI and NSTEMI cohorts. After multivariate adjustments, 1-year mortality remained significantly higher for women with STEMI (adjusted OR: 1.31 (1.09\u20131.57), p&lt;0.003) but were no longer significant for NSTEMI cohort.<\/jats:p><\/jats:sec><jats:sec id=\"sec005\"><jats:title>Conclusion<\/jats:title><jats:p>Women continued to have longer system delays, receive less aggressive pharmacotherapies and invasive treatments with poorer outcome. There is an urgent need for increased effort from all stakeholders if we are to narrow this gap.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0246474","type":"journal-article","created":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T22:25:01Z","timestamp":1612823101000},"page":"e0246474","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":50,"title":["Sex and gender differences in presentation, treatment and outcomes in acute coronary syndrome, a 10 year study from a multi-ethnic Asian population: The Malaysian National Cardiovascular Disease Database\u2014Acute Coronary Syndrome (NCVD-ACS) registry"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7706-2811","authenticated-orcid":true,"given":"Chuey Yan","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kien 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Organization","year":"2020"},{"issue":"13","key":"pone.0246474.ref002","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1093\/eurheartj\/ehz898","article-title":"Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome","volume":"41","author":"A Haider","year":"2020","journal-title":"European heart journal"},{"issue":"42","key":"pone.0246474.ref003","doi-asserted-by":"crossref","first-page":"3232","DOI":"10.1093\/eurheartj\/ehw334","article-title":"Cardiovascular disease in Europe: epidemiological update 2016","volume":"37","author":"N Townsend","year":"2016","journal-title":"European heart journal"},{"issue":"14","key":"pone.0246474.ref004","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1093\/eurheartj\/ehx097","article-title":"Acute coronary syndrome in women: rising hospitalizations in middle-aged French women, 2004\u201314","volume":"38","author":"A Gabet","year":"2017","journal-title":"European heart journal"},{"issue":"8","key":"pone.0246474.ref005","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1161\/CIRCULATIONAHA.118.037137","article-title":"Twenty Year Trends and Sex Differences in Young Adults Hospitalized With Acute Myocardial Infarction","volume":"139","author":"S Arora","year":"2019","journal-title":"Circulation"},{"issue":"8","key":"pone.0246474.ref006","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1161\/CIRCULATIONAHA.118.039298","article-title":"Myocardial Infarction in Young Women","volume":"139","author":"V Vaccarino","year":"2019","journal-title":"Circulation"},{"issue":"5","key":"pone.0246474.ref007","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1161\/01.CIR.0000116022.77781.26","article-title":"Acute Coronary Syndrome","volume":"109","author":"A Elsaesser","year":"2004","journal-title":"Circulation"},{"issue":"11","key":"pone.0246474.ref008","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1136\/hrt.2006.106781","article-title":"Gender differences in management and outcomes in patients with acute coronary syndromes: results on 20,290 patients from the AMIS Plus Registry","volume":"93","author":"D Radovanovic","year":"2007","journal-title":"Heart (British Cardiac Society)"},{"issue":"1","key":"pone.0246474.ref009","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.ahj.2011.09.025","article-title":"Bridging the gender gap: Insights from a contemporary analysis of sex-related differences in the treatment and outcomes of patients with acute coronary syndromes","volume":"163","author":"S Poon","year":"2012","journal-title":"American heart journal"},{"issue":"8","key":"pone.0246474.ref010","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1038\/nrcardio.2016.89","article-title":"Acute coronary syndromes in women and men","volume":"13","author":"NJ Pagidipati","year":"2016","journal-title":"Nature reviews Cardiology"},{"issue":"1","key":"pone.0246474.ref011","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1093\/eurheartj\/ehv598","article-title":"Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes","volume":"37","author":"V Regitz-Zagrosek","year":"2016","journal-title":"European heart journal"},{"issue":"4","key":"pone.0246474.ref012","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.gheart.2014.06.001","article-title":"Sex differences in acute coronary syndrome in a multi-ethnic Asian population: results of the Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) registry","volume":"9","author":"HT Lu","year":"2014","journal-title":"Glob Heart"},{"issue":"11","key":"pone.0246474.ref013","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1136\/hrt.2006.102012","article-title":"Gender differences in management and outcome in non-ST-elevation acute coronary syndrome","volume":"93","author":"J Alfredsson","year":"2007","journal-title":"Heart (British Cardiac Society)"},{"issue":"1","key":"pone.0246474.ref014","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1136\/hrt.2007.138537","article-title":"Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events","volume":"95","author":"S Dey","year":"2009","journal-title":"Heart (British Cardiac Society)"},{"issue":"8","key":"pone.0246474.ref015","doi-asserted-by":"crossref","first-page":"e72382","DOI":"10.1371\/journal.pone.0072382","article-title":"Are There Gender Differences in Coronary Artery Disease? The Malaysian National Cardiovascular Disease Database\u2014Percutaneous Coronary Intervention (NCVD-PCI) Registry","volume":"8","author":"CY Lee","year":"2013","journal-title":"PLOS ONE"},{"issue":"6","key":"pone.0246474.ref016","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1161\/01.CIR.91.6.1861","article-title":"Sex differences in mortality after myocardial infarction. Is there evidence for an increased risk for women?","volume":"91","author":"V Vaccarino","year":"1995","journal-title":"Circulation"},{"issue":"5","key":"pone.0246474.ref017","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1001\/archinte.1992.00400170062012","article-title":"Gender differences in the treatment and outcome of acute myocardial infarction. Results from the Myocardial Infarction Triage and Intervention Registry","volume":"152","author":"C Maynard","year":"1992","journal-title":"Archives of internal medicine"},{"issue":"4","key":"pone.0246474.ref018","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1161\/01.CIR.90.4.1715","article-title":"Sex differences in the management and long-term outcome of acute myocardial infarction. A statewide study. MIDAS Study Group. Myocardial Infarction Data Acquisition System","volume":"90","author":"JB Kostis","year":"1994","journal-title":"Circulation"},{"issue":"7","key":"pone.0246474.ref019","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1016\/S0735-1097(97)00077-6","article-title":"Hospital Mortality in Women and Men With Acute Cardiac Ischemia: A Prospective Multicenter Study","volume":"29","author":"BE Coronado","year":"1997","journal-title":"Journal of the American College of Cardiology"},{"issue":"3","key":"pone.0246474.ref020","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/S0735-1097(01)01465-6","article-title":"Gender and survival: a population-based study of 201,114 men and women following a first acute myocardial infarction","volume":"38","author":"K MacIntyre","year":"2001","journal-title":"J Am Coll Cardiol"},{"issue":"9","key":"pone.0246474.ref021","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1161\/CIRCULATIONAHA.114.009480","article-title":"Sex differences in long-term mortality after myocardial infarction: a systematic review","volume":"130","author":"EM Bucholz","year":"2014","journal-title":"Circulation"},{"issue":"Suppl C","key":"pone.0246474.ref022","first-page":"29","article-title":"Acute coronary syndrome (ACS) registry\u2014leading the charge for National Cardiovascular Disease (NCVD) Database","volume":"63","author":"SP Chin","year":"2008","journal-title":"The Medical journal of Malaysia"},{"key":"pone.0246474.ref023","unstructured":"Wan Ahmad WA, Sim KH. National Cardiovascular Disease Database (NCVD): Inaugural Report of the Acute Coronary Syndrome Registry 2007 & 2008. Kuala Lumpur: National Heart Association of Malaysia; 2008."},{"issue":"8","key":"pone.0246474.ref024","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1016\/j.amjcard.2009.06.003","article-title":"Comparison of men and women with acute coronary syndrome in six Middle Eastern countries","volume":"104","author":"A El-Menyar","year":"2009","journal-title":"The American journal of cardiology"},{"issue":"4","key":"pone.0246474.ref025","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/S0002-9149(02)02489-X","article-title":"Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE)","volume":"90","author":"PG Steg","year":"2002","journal-title":"The American journal of cardiology"},{"issue":"9622","key":"pone.0246474.ref026","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1016\/S0140-6736(08)60623-6","article-title":"Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data","volume":"371","author":"D Xavier","year":"2008","journal-title":"Lancet (London, England)"},{"key":"pone.0246474.ref027","unstructured":"Department of Statistics Malaysia. Population and dermography statistics 2019 [https:\/\/www.dosm.gov.my]."},{"issue":"1","key":"pone.0246474.ref028","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/S0735-1097(97)00107-1","article-title":"Outcome and profile of women and men presenting with acute coronary syndromes: a report from TIMI IIIB","volume":"30","author":"TIMI Investigators","year":"1997","journal-title":"Journal of the American College of Cardiology"},{"issue":"8","key":"pone.0246474.ref029","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1161\/CIRCULATIONAHA.117.031650","article-title":"Sex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction: Evidence from the VIRGO Study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients)","volume":"137","author":"JH Lichtman","year":"2018","journal-title":"Circulation"},{"issue":"16","key":"pone.0246474.ref030","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1056\/NEJM200004203421603","article-title":"Missed diagnoses of acute cardiac ischemia in the emergency department","volume":"342","author":"JH Pope","year":"2000","journal-title":"The New England journal of medicine"},{"issue":"8","key":"pone.0246474.ref031","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1001\/jama.2009.1227","article-title":"Sex differences in mortality following acute coronary syndromes","volume":"302","author":"JS Berger","year":"2009","journal-title":"JAMA"},{"issue":"1","key":"pone.0246474.ref032","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1161\/CIRCOUTCOMES.108.818500","article-title":"Impact of depression on sex differences in outcome after myocardial infarction","volume":"2","author":"S Parashar","year":"2009","journal-title":"Circ Cardiovasc Qual 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Interventions","volume":"87","author":"GN Levine","year":"2016","journal-title":"Catheterization and cardiovascular interventions: official journal of the Society for Cardiac Angiography & Interventions"},{"issue":"4","key":"pone.0246474.ref035","doi-asserted-by":"crossref","first-page":"e78","DOI":"10.1016\/j.jacc.2012.11.019","article-title":"2013 ACCF\/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines","volume":"61","author":"PT O\u2019Gara","year":"2013","journal-title":"Journal of the American College of Cardiology"},{"issue":"25","key":"pone.0246474.ref036","doi-asserted-by":"crossref","first-page":"2354","DOI":"10.1161\/CIR.0000000000000133","article-title":"2014 AHA\/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: Executive Summary","volume":"130","author":"EA Amsterdam","year":"2014","journal-title":"Circulation"},{"issue":"3","key":"pone.0246474.ref037","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.pcad.2010.07.004","article-title":"Diagnosis and treatment of heart disease: are women different from men?","volume":"53","author":"B Xhyheri","year":"2010","journal-title":"Progress in cardiovascular diseases"},{"issue":"2","key":"pone.0246474.ref038","doi-asserted-by":"crossref","first-page":"e55508","DOI":"10.1371\/journal.pone.0055508","article-title":"Gender Disparities in the Presentation, Management and Outcomes of Acute Coronary Syndrome Patients: Data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2)","volume":"8","author":"A Shehab","year":"2013","journal-title":"PLOS ONE"},{"issue":"6","key":"pone.0246474.ref039","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1097\/MCA.0b013e32833ce07c","article-title":"Age and sex differences, and changing trends, in the use of evidence-based therapies in acute coronary syndromes: perspectives from a multinational registry","volume":"21","author":"HL Nguyen","year":"2010","journal-title":"Coronary artery disease"},{"issue":"11","key":"pone.0246474.ref040","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1093\/eurheartj\/ehr027","article-title":"Factors influencing underutilization of evidence-based therapies in women","volume":"32","author":"R Bugiardini","year":"2011","journal-title":"European heart journal"},{"issue":"7","key":"pone.0246474.ref041","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1161\/CIRCULATIONAHA.106.664979","article-title":"Gender differences in hospital mortality and use of percutaneous coronary intervention in acute myocardial infarction: microsimulation analysis of the 1999 nationwide French hospitals database","volume":"115","author":"C Milcent","year":"2007","journal-title":"Circulation"},{"issue":"10","key":"pone.0246474.ref042","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1016\/j.jacc.2005.05.091","article-title":"Differences in the management and prognosis of women and men who suffer from acute coronary syndromes","volume":"46","author":"SS Anand","year":"2005","journal-title":"J Am Coll Cardiol"},{"issue":"8","key":"pone.0246474.ref043","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1056\/NEJM199902253400806","article-title":"The Effect of Race and Sex on Physicians\u2019 Recommendations for Cardiac Catheterization","volume":"340","author":"KA Schulman","year":"1999","journal-title":"New England Journal of Medicine"},{"issue":"3 Suppl","key":"pone.0246474.ref044","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.1016\/j.jacc.2004.12.084","article-title":"Insights from the NHLBI-Sponsored Women\u2019s Ischemia Syndrome Evaluation (WISE) Study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease","volume":"47","author":"CN Bairey Merz","year":"2006","journal-title":"J Am Coll Cardiol"},{"issue":"2","key":"pone.0246474.ref045","first-page":"110","article-title":"Assessment of women with suspected myocardial ischemia: review of findings of the Women\u2019s Ischemia Syndrome Evaluation (WISE) Study","volume":"2","author":"JF Lewis","year":"2002","journal-title":"Current women\u2019s health reports"},{"issue":"3","key":"pone.0246474.ref046","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0002-9343(02)01221-4","article-title":"Racial and sex differences in refusal of coronary angiography","volume":"113","author":"PA Heidenreich","year":"2002","journal-title":"The American journal of medicine"},{"issue":"9","key":"pone.0246474.ref047","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1016\/S0002-9149(96)00523-1","article-title":"Influence of gender, race, and education on patient preferences and receipt of cardiac catheterizations among coronary care unit patients","volume":"78","author":"AD Schecter","year":"1996","journal-title":"The American journal of cardiology"},{"issue":"1","key":"pone.0246474.ref048","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.ahj.2008.08.012","article-title":"Gender differences among patients with acute coronary syndromes undergoing percutaneous coronary intervention in the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR)","volume":"157","author":"N Akhter","year":"2009","journal-title":"American heart journal"},{"issue":"5","key":"pone.0246474.ref049","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1016\/j.ahj.2011.07.029","article-title":"Management of acute coronary syndromes in developing countries: acute coronary events-a multinational survey of current management strategies","volume":"162","author":"The ACCESS Investigators","year":"2011","journal-title":"American heart journal"},{"issue":"3","key":"pone.0246474.ref050","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.ahj.2013.11.001","article-title":"Age and sex differences in inhospital complication rates and mortality after percutaneous coronary intervention procedures: evidence from the NCDR(\u00ae)","volume":"167","author":"JH Lichtman","year":"2014","journal-title":"American heart journal"},{"issue":"23","key":"pone.0246474.ref051","doi-asserted-by":"crossref","first-page":"2556","DOI":"10.1016\/j.jacc.2009.09.076","article-title":"A risk score to predict bleeding in patients with acute coronary syndrome","volume":"55","author":"R Mehran","year":"2010","journal-title":"J AM Coll Cardiol"},{"issue":"13","key":"pone.0246474.ref052","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1161\/CIRCULATIONAHA.106.620815","article-title":"Sex differences in major bleeding with glycoprotein IIb\/IIIa inhibitors: results from the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC\/AHA guidelines) initiative","volume":"114","author":"KP Alexander","year":"2006","journal-title":"Circulation"},{"issue":"10","key":"pone.0246474.ref053","doi-asserted-by":"crossref","first-page":"911","DOI":"10.2169\/internalmedicine.43.911","article-title":"Increased cardiac mortality in women compared with men in patients with acute myocardial infarction","volume":"43","author":"K Kanamasa","year":"2004","journal-title":"Internal medicine (Tokyo, Japan)"},{"issue":"1","key":"pone.0246474.ref054","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.116.004521","article-title":"Impact of Sex and Contact-to-Device Time on Clinical Outcomes in Acute ST-Segment Elevation Myocardial Infarction-Findings From the National Cardiovascular Data Registry","volume":"6","author":"RO Roswell","year":"2017","journal-title":"Journal of the American Heart Association"},{"key":"pone.0246474.ref055","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.ahj.2017.06.005","article-title":"Sex-based differences in quality of care and outcomes in a health system using a standardized STEMI protocol","volume":"191","author":"J Wei","year":"2017","journal-title":"American heart journal"},{"issue":"3","key":"pone.0246474.ref056","first-page":"143","article-title":"ESC working group position paper on myocardial infarction with non-obstructive coronary arteries","volume":"38","author":"S Agewall","year":"2017","journal-title":"European heart journal"},{"key":"pone.0246474.ref057","first-page":"375","article-title":"Acute coronary syndrome in women of reproductive age","volume":"3","author":"N Idris","year":"2011","journal-title":"Int J Womens Health"},{"issue":"18","key":"pone.0246474.ref058","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1016\/j.jacc.2015.08.859","article-title":"Sex Differences in Cardiac Risk Factors, Perceived Risk, and Health Care Provider Discussion of Risk and Risk Modification Among Young Patients With Acute Myocardial Infarction","volume":"66","author":"EC Leifheit-Limson","year":"2015","journal-title":"Journal of the American College of Cardiology"},{"issue":"15","key":"pone.0246474.ref059","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1161\/CIRCULATIONAHA.114.012293","article-title":"Sex differences in reperfusion in young patients with ST-segment-elevation myocardial infarction: results from the VIRGO study","volume":"131","author":"G D\u2019Onofrio","year":"2015","journal-title":"Circulation"}],"container-title":["PLOS 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