In-hospital mortality was worse for women with ACS, but after multivariate adjustment in STEMI patients, the gender mortality difference was not significant (OR 2.0; 95% CI 0.7-5.5; P=0.14).
Cohort (n=5,061)
Yes
Does female gender impact in-hospital mortality in patients with acute coronary syndrome?
While unadjusted in-hospital mortality is higher in women with ACS, this difference is largely driven by age and baseline risk factors rather than gender alone.
Effect estimate: OR 2.0 (95% CI 0.7-5.5)
p-value: p=.14
BACKGROUND AND OBJECTIVES: Gender associations with acute coronary syndrome (ACS), remain inconsistent. Gender-specific data in the Saudi Project for Assessment of Coronary Events registry, launched in December 2005 and currently with 17 participating hospitals, were explored. DESIGN AND SETTINGS: A prospective multicenter study of patient with ACS in secondary and tertiary care centers in Saudi Arabia were included in this analysis. PATIENTS AND METHODS: Patients enrolled from December 2005 until December 2007 included those presented to participating hospitals or transferred from non-registry hospitals. Summarized data were analyzed. RESULTS: Of 5061 patients, 1142 (23%) were women. Women were more frequently diagnosed with non ST-segment elevation myocardial infarction (NSTEMI 43%) than unstable angina (UA 29%) or ST-segment elevation myocardial infarction (STEMI 29%). More men had STEMI (42%) than NSTEMI (37%) or UA (22%). Men were younger than women (57 vs 63 years) who had more diabetes, hypertension, and hyperlipidemia. More men had a history of coronary artery disease. More women received angiotensin receptor blockers (ARB) and fewer had percutaneous coronary intervention (PCI). Gender differences in the subset of STEMI patients were similar to those in the entire cohort. However, gender differences in the subset of STEMI showed fewer women given b-blockers, and an insignificant PCI difference between genders. Thrombolysis rates between genders were similar. Overall, in-hospital mortality was significantly worse for women and, by ACS type, was significantly greater in women for STEMI and NSTEMI. However, after age adjustment there was no difference in mortality between men and women in patients with NSTEMI. The multivariate-adjusted (age, risk factors, treatments, door-to-needle time) STEMI gender mortality difference was not significant (OR=2.0, CI: 0.7-5.5; P=.14). CONCLUSION: These data are similar to other reported data. However, differences exist, and their explanation should be pursued to provide a valuable insight into understanding ACS and improving its management.
Hersi et al. (2013) conducted a cohort in Acute coronary syndrome (ACS) (n=5,061). Female gender vs. Male gender was evaluated on In-hospital mortality (multivariate-adjusted for STEMI) (OR 2.0, 95% CI 0.7-5.5, p=.14). In-hospital mortality was worse for women with ACS, but after multivariate adjustment in STEMI patients, the gender mortality difference was not significant (OR 2.0; 95% CI 0.7-5.5; P=0.14).