Abstract 12130: Outcomes in Women Compared With Men in Patients With Unstable Angina/Non-ST-Segment Elevation Myocardial Infarction Managed Without Revascularization: Insights From the TRILOGY ACS Trial
Background: In patients with unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI), women are less likely than men to be managed invasively, and have higher risk for subsequent ischemic events. Comparative outcomes in female vs male UA/NSTEMI patients managed primarily without revascularization remain largely unknown.
Methods: TRILOGY ACS compared prasugrel vs clopidogrel (each added to aspirin) in 9326 UA/NSTEMI patients managed without revascularization and with ≥1 high-risk criterion. Participants were enrolled from 52 countries from June 2008-September 2011; median follow-up was 17 months. Univariable and multivariable Cox regression was used to compare crude and adjusted association of sex with the primary composite outcome (cardiovascular death, MI, or stroke) and its components as well as all-cause mortality.
Results: (Table) Women (n=3650/9326; 39%) vs men were older, less likely to have NSTEMI as the qualifying event, prior MI, or prior coronary revascularization, and more likely to have hypertension, diabetes, atrial fibrillation, and higher GRACE risk score. There was no statistical difference in crude risk for the composite of CV death/MI/stroke, for each component endpoint, or for all-cause death between women and men. However, after multivariable adjustment, women had significantly lower adjusted risk for the composite endpoint, CV death, and all-cause death at 30 months.
Conclusions: Contrary to previous studies, we observed no difference between sexes in intermediate-term outcomes among patients with UA/NSTEMI managed without revascularization, despite the higher baseline risk profile of women. After adjustment, women actually had lower risk for major adverse CV events, including CV and all-cause mortality. These data emphasize that previously reported sex-based differences in post-ACS outcomes are most appropriately interpreted in the context of applied therapeutic strategies and length of follow-up.
- © 2013 by American Heart Association, Inc.