May 7, 2015Open Access
View Full PaperSex-related differences in baseline characteristics, management and outcome in patients with acute coronary syndrome without ST-segment elevation
Key Result
Female sex was not associated with worse long-term all-cause mortality compared with men after adjustment for baseline characteristics and treatment (HR 1.14; 95% CI 0.89-1.47; p=0.307).
Study Design
Type
Cohort (n=812)
Multicenter
No
Structured PICO
Does female sex independently predict worse long-term mortality or lower rates of early invasive therapy in patients with NSTE-ACS?
P
Population
812 consecutive patients admitted for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) between 2001 and 2004 (342 women and 440 men with 7-year follow-up).
I
Intervention
Female sex
C
Comparator
Male sex
O
Outcome
All-cause mortality at 7-year follow-uphard clinical
Women with NSTE-ACS receive less early invasive therapy primarily due to older age and renal insufficiency, but female sex itself is not an independent predictor of worse long-term mortality.
Main Result
Effect estimate: HR 1.14 (95% CI 0.89-1.47)
Absolute Event Rate: 54.8% vs 39.3%
p-value: p=0.307
Abstract
AIM: To detect sex-related differences in baseline characteristics, management and outcome in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). METHODS: Data from 812 consecutive patients admitted to our cardiology department for NSTE-ACS between 2001 and 2004 were obtained. Early invasive therapy was defined as revascularization during first hospital stay. A seven-year follow-up for the clinical endpoint of all-cause mortality could be obtained in 342 women and 440 men, respectively. RESULTS: Compared with men, women were significantly older and more likely to suffer from renal insufficiency. The proportion treated with clopidogrel at admission was 43.6% for women and 52.7% for men, respectively (p=0.011). Significantly fewer women underwent an early invasive therapy compared with men (27.5% vs. 35.2%; p=0.021). Age and renal insufficiency were the strongest predictors for a conservative approach in both female and male patients. After adjustment for baseline characteristics there was no significant difference in treatment between women and men (odds ratio 0.89; 95% confidence interval 0.59-1.35; p=0.588). While in-hospital mortality was similar between the sexes, long-term mortality was significantly higher in women compared with men (8.2% vs. 7.0%; p=0.549 for in-hospital mortality and 54.8% vs. 39.3%; p<0.001 for seven-year mortality). However, after adjustment for baseline characteristics and treatment there was no significant difference in long-term mortality between women and men (hazard ratio 1.14; 95% confidence interval 0.89-1.47; p=0.307). CONCLUSION: In these patients with NSTE-ACS women were less likely to undergo an early invasive therapy compared with men due to their higher age and the higher rate of renal insufficiency. After adjustment for age, comorbidities and treatment female sex was not associated with worse long-term outcome.