Abstract 18737: Sex Differences in Mortality in Women and Men with Obstructive Coronary Artery Disease and Acute Coronary Syndrome
Introduction: There is controversy whether there are sex differences in mortality following ACS.
Hypothesis: Comparisons are confounded by the lower likelihood of obstructive CAD in women than men, and by the less frequent use of coronary angiography, revascularization and evidence-based therapies. All of these factors may affect prognosis.
Methods: The International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC, NCT01218776), enrolled 6811 ACS patients (4908 men and 1903 women) who underwent coronary angiography during their hospitalization. We investigated sex differences in-hospital mortality among patients with confirmed obstructive CAD, defined as ≥50% stenosis in ≥1 epicardial coronary artery. Cox proportional hazards regression model was adjusted to covariates significantly different between groups in univariate analysis. The primary endpoint was in-hospital death; the secondary endpoint was the composite of in-hospital death, stent thrombosis, and stroke or major bleeding.
Results: Among patients who underwent coronary angiography, the majority had obstructive CAD (6531/6811, 95.9%). Women (1786/1903, 93.9%) with obstructive CAD had a higher rate of death than men (6.4% vs. 3.2%, p<0.001) (Figure A). After multivariable adjustment for baseline and treatment covariates, female sex remained significantly associated with a higher risk of death (Figure B) (HR: 1.67; CI: 1.18-2.37, p=0.004). Women had also a higher hazard for the secondary endpoint (HR: 1.66; CI: 1.21- 2.28, p=0.002) compared with men.
Conclusions: Women with ACS and documented obstructive CAD have higher short term mortality despite adjustment for clinical factors, revascularization and evidence-based therapies as compared with men. These data suggest that knowledge of coronary anatomy and treatment variables are critical to the accurate assessment of differences in outcomes among ACS women and men.
Author Disclosures: E. Cenko: None. S. Kedev: None. S. Antov: None. Z. Vasiljevic: None. M. Dorobantu : None. O. Gustiene: None. B. Knezevic: None. D. Milicic: None. M. Dilic: None. D. Trninic: None. O. Manfrini: None. R. Bugiardini: None.
- © 2014 by American Heart Association, Inc.