Abstract 6083: Sex Differences in 1-Year Mortality Following Acute Coronary Syndromes
Background: There is conflicting information whether sex modulates mortality following acute coronary syndromes (ACS). We investigated the relationships between sex, other clinical characteristics and 1-year mortality across the spectrum of ACS using a large database.
Methods: Data from 6 ACS trials encompassing 1993 to 2006 were pooled. Of 81,010 patients, 21,409 (26%) were women. The ACS spectrum included 57,113 (24% women) STEMI, 13,376 (29% women) NSTEMI and 10,523 (39% women) unstable angina (UA). We compared 1-year mortality of women versus men in those surviving at least 30 days post ACS after multivariable adjustment using previously validated STEMI and NSTEMI/UA mortality models and coronary anatomy,
Results: In the combined ACS population, women had higher unadjusted risk (HR 1.26, 95% CI 1.16 –1.36) compared with men. A significant interaction between sex and type of ACS was detected (P<0.001). Women had an increased unadjusted 1-year mortality risk in STEMI (HR 1.43, 95% CI 1.30 –1.58) and NSTEMI (HR 1.17, 95% CI 0.98 –1.39) but a decreased risk in UA (HR 0.84, 95% CI 0.69 –1.02) compared with men. After adjustment for baseline characteristics (age, heart rate, systolic blood pressure, weight, race, Killip class, smoking status, and history of diabetes, heart failure, myocardial infarction or bypass surgery) women had a lower risk of 1-year mortality for each type of ACS (STEMI, HR 0.86, 95% CI 0.77– 0.96; NSTEMI, HR 0.81, 95% CI 0.67– 0.97; and UA, HR 0.65, 95% CI 0.53– 0.79). After further adjustment for in-hospital procedures and coronary anatomy, hazard ratios were unchanged and mortality at 1-year remained lower for women in all ACS types.
Conclusions: Sex-based differences exist in unadjusted 1-year mortality following ACS and vary by type of clinical syndrome. Adjustment for baseline differences, in-hospital procedures and coronary anatomy reveal that women are actually at lower risk for 1-year mortality compared with men across the spectrum of ACS.