Sex, Clinical Presentation, and Outcome in Patients with Acute Coronary Syndromes

TLDR

Women with acute myocardial infarction have worse in‑hospital and long‑term outcomes than men. This study examined sex‑based differences in presentation and outcomes among 12,142 acute coronary syndrome patients in the GUSTO‑IIb trial. The authors analyzed data from the GUSTO‑IIb study, enrolling 12,142 patients (3,662 women, 8,480 men) with various ACS types, and compared baseline characteristics and clinical outcomes. Women were older, had more comorbidities, lower rates of prior MI and smoking, presented less often with ST‑elevation infarction, experienced more complications and higher 30‑day mortality, and exhibited a higher risk of death or reinfarction in STEMI but a protective effect in unstable angina, indicating sex‑specific clinical profiles that cannot be fully explained by baseline differences.

Abstract

Studies have reported that women with acute myocardial infarction have in-hospital and long-term outcomes that are worse than those of men.To assess sex-based differences in presentation and outcome, we examined data from the Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb study, which enrolled 12,142 patients (3662 women and 8480 men) with acute coronary syndromes, including infarction with ST-segment elevation, infarction with no ST-segment elevation, and unstable angina.Overall, the women were older than the men, and had significantly higher rates of diabetes, hypertension, and prior congestive heart failure. They had significantly lower rates of prior myocardial infarction and were less likely ever to have smoked. A smaller percentage of women than men had infarction with ST elevation (27.2 percent vs. 37.0 percent, P<0.001), and of the patients who presented with no ST elevation (those with myocardial infarction or unstable angina), fewer women than men had myocardial infarction (36.6 percent vs. 47.6 percent, P<0.001). Women had more complications than men during hospitalization and a higher mortality rate at 30 days (6.0 percent vs. 4.0 percent, P<0.001) but had similar rates of reinfarction at 30 days after presentation. However, there was a significant interaction between sex and the type of coronary syndrome at presentation (P=0.001). After stratification according to coronary syndrome and adjustment for base-line variables, there was a nonsignificant trend toward an increased risk of death or reinfarction among women as compared with men only in the group with infarction and ST elevation (odds ratio, 1.27; 95 percent confidence interval, 0.98 to 1.63; P=0.07). Among patients with unstable angina, female sex was associated with an independent protective effect (odds ratio for infarction or death, 0.65; 95 percent confidence interval, 0.49 to 0.87; P=0.003).Women and men with acute coronary syndromes had different clinical profiles, presentation, and outcomes. These differences could not be entirely accounted for by differences in base-line characteristics and may reflect pathophysiologic and anatomical differences between men and women.