Abstract 16958: Are We There Yet? Dissipating Sex Differences in Acute Coronary Syndromes. A Population Level Examination
Objectives: Cardiovascular disease is a leading cause of death among both men and women in North America. Using a 12-year population-level cohort of patients hospitalized with acute coronary syndromes (ACS), in a geographically defined area (province of Alberta, Canada), with universal health care access, we examined sex differences in: 1) age at presentation by ACS subtype (STEMI/ NSTEMI/unstable angina (UA)); 2) comorbidity and procedure rates; 3) evidenced-based medications (EBM) 6 months prior to and post ACS event; and 4) 5-year mortality.
Methods: There were 17,277 women and 36,274 men aged >20 years hospitalized with ACS between 01/04/2002 - 31/12/2013. Vital status as of 31/12/2013 was available for all patients. Cox regression models were used to examine adjusted sex differences in 5-year mortality.
Results: ACS prevalence differed by sex and age (Figure). In STEMI, women had more comorbidities than men, but not among NSTEMI and UA patients. Procedure use was similar among men and women with STEMI, but lower among women than men with NSTEMI and UA. EBM rates after ACS were significantly higher than prior to the event, and were similar in both sexes. There was no sex difference in the adjusted hazard ratio (aHR) for 5-year mortality in STEMI, overall (aHR 1.04, 95% CI: 0.97 – 1.12) or when stratified by age (<65/≥65 years). Overall, women had a lower risk of mortality among patients with NSTEMI (aHR 0.9, 95% CI: 0.86 – 0.95) and UA (aHR 0.9, 95% CI: 0.81 – 0.99), primarily as a result of lower mortality risk among elderly patients.
Conclusions: We provide novel data on sex differences in ACS prevalence and outcomes by ACS subtype. In STEMI, in conjunction with the advent of system-wide standardized clinical protocols, sex differences in treatment and outcomes have been nullified. However, sex differences remain in NSTEMI and UA where more subjective clinical decision-making is involved.
Author Disclosures: P. Kaul: None. A. Savu: None. L.K. Newby: None.
- © 2016 by American Heart Association, Inc.