Key result
Elderly female sex post-ACS is linked to ~42% lower long-term mortality than men despite higher admission risk.
Why the study?
Poor outcomes have been reported among women after ACS, but long-term outcomes comparing female and male elderly patients remained to be assessed.
Does female gender impact long-term mortality and rehospitalization in elderly patients (≥75 years) with acute coronary syndromes?
Does female gender impact long-term mortality and rehospitalization in elderly patients (≥75 years) with acute coronary syndromes?
In elderly patients (≥75 years) with ACS, female gender is independently associated with a lower long-term risk of mortality compared to men, despite older age and higher risk profiles at admission.
Elderly women post-ACS had lower mortality despite higher risks; challenges prior reports of worse female outcomes but observational data leave causality open.
Background Poor outcome has been reported among women after acute coronary syndromes (ACS). Purpose We aimed to assess the long term outcome after ACS between female and male patients in a prospective cohort of elderly (≥75 years) patients. Methods A total of 1079 among whom 456 (42%) female patients were followed-up for a median time of 6.7 years. Patients had a comprehensive assessment of geriatric parameters including Activities of Daily Living (ADL) and Mini Mental Status Evaluation (MMSE) scores at admission. Yearly follow-up was performed in all patients with respect to mortality and rehospitalization. A cox model adjusted on predefined admission variables (age, revascularisation, GRACE score, CRUSADE score, MMSE score, ADL score) and variables differently distributed between gender groups with a p value <0.05 was used to assess the impact of gender on long-term outcome. Results At presentation women were significantly older (84±5 versus 82±5 years p<0.005), had higher rates of hypertension (p=0.02), antidepressant (p=0.03) and benzodiazepine (p<0.0005) use; higher GRACE (p=0.03), CRUSADE (p<0.005) and ADL (p=0.02) scores; lower rates of myocardial infarction (p<0.005) and active smoking compared (p<0.005), lower GFR (p=0.03) and MMSE score (<0.005). Rates of revascularization and treatment at discharge were similar between the groups. At follow-up female gender was independently associated with lower mortality rates (HR 0.58, 95%CI [0.47-0.71], p<0.005) but not rehospitalization (HR 0.88 95%CI [0.7 to 1.1], p=0.1). Other independent correlates of mortality were lower age and GFR, active smoking, absence of revascularization, higher crusade and lower MMSE and ADL scores). Conclusions Despite older age and higher risk profiles at admission, elderly women have a lower long-term risk of mortality after ACS when managed adequately and similarly to men. Our study also highlights the importance of geriatric markers of dependence and cognitive function as independent correlates of poor outcome after ACS in elderly patients.Survival curve
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Lacote et al. (2025) studied this question. Elderly women after ACS had 42% lower long-term mortality risk than men (HR 0.58, 95%CI 0.47-0.71), despite higher risk profiles at admission.
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