Contemporary Sex-Based Differences by Age in Presenting Characteristics, Use of an Early Invasive Strategy, and Inhospital Mortality in Patients With Non–ST-Segment–Elevation Myocardial Infarction in the United States

Gupta, Tanush; Kolte, Dhaval; Khera, Sahil; Agarwal, Nayan; Villablanca, Pedro A.; Goel, Kashish; Patel, Kavisha; Aronow, Wilbert S.; Wiley, Jose; Bortnick, Anna E.; Aronow, Herbert D.; Abbott, J. Dawn; Pyo, Robert; Panza, Julio A.; Menegus, Mark; Rihal, Charanjit S.; Fonarow, Gregg C.; García, Mario J.; Bhatt, Deepak L.

doi:10.1161/circinterventions.117.005735

Cited by 54 publications

(39 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Female gender has traditionally been linked to adverse outcomes following an ACS event or after PCI in earlier studies, an observation which has at least in part been attributed to the overall increased cardiovascular risk profile in women and a less aggressive treatment approach . Recent reports in contemporary coronary angioplasty practice, however, challenged this observation by demonstrating similar or even better outcomes in women with ACS . In line with our findings, admission database, pooled registry and trial data demonstrated similar in‐hospital and better 1‐year outcomes in elderly women with NSTEMI/unstable angina, although these patient cohorts were limited by a rather low number of patients referred to coronary angiography and undergoing coronary revascularization.…”

Section: Discussionsupporting

confidence: 85%

“…6,7,27 Recent reports in contemporary coronary angioplasty practice, however, challenged this observation by demonstrating similar or even better outcomes in women with ACS. 17,18,[38][39][40] In line with our findings, admission database, pooled registry and trial data demonstrated similar in-hospital and better 1-year outcomes in elderly women with NSTEMI/unstable angina, 17,38 although these patient cohorts were limited by a rather low number of patients referred to coronary angiography and undergoing coronary revascularization. Similarly, age-specific genderdifferences in outcomes in STEMI patients have been described with increased mortality rates observed in younger, but not elderly women.…”

Section: Coronary Revascularization Rates Were Lower In Elderly Patientssupporting

confidence: 76%

See 1 more Smart Citation

Gender and age differences in outcomes of patients with acute coronary syndromes referred for coronary angiography

Stähli

Wischnewsky

Jakob

et al. 2018

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objectives The number of elderly patients undergoing coronary revascularization is steadily increasing, and data on the impact of gender on outcomes are scarce. This study sought to assess gender‐related differences in outcomes in elderly patients with acute coronary syndromes (ACS). Methods We investigated outcomes in elderly ACS patients referred for coronary angiography and prospectively enrolled in the Swiss ACS Cohort between December 2009 and October 2012. Adjudicated major adverse cardiovascular and cerebrovascular events (MACCE) included all‐cause death, non‐fatal myocardial infarction, clinically indicated repeat coronary revascularization, definite stent thrombosis, and transient ischemic attack/stroke. Results Among 2,168 patients recruited, 481 (22%) patients were >75 years of age (37% women). In patients >75 years, 1‐year MACCE rates were 15% and 23% in women and men (OR 0.59, 95% CI 0.36–0.97, P = 0.04), respectively, and differences remained significant after adjustments for baseline variables (adjusted OR 0.48, 95% CI 0.26–0.90, P = 0.02). Women >75 years had a lower cardiovascular mortality (6% versus 12%, adjusted OR 0.31, 95% CI 0.12–0.81, P = 0.02). In patients ≤75 years, 1‐year MACCE rates did not differ between gender (10% and 8% for women and men, adjusted OR 1.28, 95% CI 0.77–2.14, P = 0.34). Rates of TIMI major bleeding for women and men were 4% and 4% in patients >75 years (P = 0.96), and 5% and 3% in those ≤75 years (P = 0.11). Conclusions The low rates of MACCE observed in elderly women in this patient cohort suggest that with current interventional strategies the gender gap in ACS management has been attenuated.

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Coronary Revascularization Rates Were Lower In Elderly Patientssupporting

confidence: 76%

Gender and age differences in outcomes of patients with acute coronary syndromes referred for coronary angiography

Stähli

Wischnewsky

Jakob

et al. 2018

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…In addition, a recent report confirmed that women with NSTE-ACS ≥70 years of age had better outcomes than those <70 years [8]. Another study using data from the National Inpatient Sample (NIS) database in the United States indicated that women had lower risk-adjusted in-hospital mortality than men after accounting for differences in age and comorbidities [16]. ese findings suggested that the relation between sex and mortality was age-dependent, with increased mortality in women at a young age and decreased mortality in women at an advanced age.…”

Section: Discussionmentioning

confidence: 98%

Sex Differences in the Outcomes of Elderly Patients with Acute Coronary Syndrome

Tai

Yang

et al. 2020

Cardiology Research and Practice

View full text Add to dashboard Cite

Background. The impact of sex on the outcome of patients with acute coronary syndrome (ACS) has been suggested, but little is known about its impact on elderly patients with ACS. Methods. This study analyzed the impact of sex on in-hospital and 1-year outcomes of elderly (≥75 years of age) patients with ACS hospitalized in our department between January 2013 and December 2017. Results. A total of 711 patients were included: 273 (38.4%) women and 438 (61.6%) men. Their age ranged from 75 to 94 years, similar between women and men. Women had more comorbidities (hypertension (79.5% vs. 72.8%, p=0.050), diabetes mellitus (35.2% vs. 26.5%, p=0.014), and hyperuricemia (39.9% vs. 32.4%, p=0.042)) and had a higher prevalence of non-ST-segment elevation ACS (NSTE-ACS) (79.5% vs. 71.2%, p=0.014) than men. The prevalence of current smoking (56.5% vs. 5.4%, p<0.001), creatinine levels (124.4 ± 98.6 vs. 89.9 ± 54.1, p<0.001), and revascularization rate (39.7% vs. 30.0%, p=0.022) were higher, and troponin TnT and NT-proBNP tended to be higher in men than in women. The in-hospital mortality rate was similar (3.5% vs. 4.4%, p=0.693), but the 1-year mortality rate was lower in women than in men (14.7% vs. 21.7%, p=0.020). The multivariable analysis showed that female sex was a protective factor for 1-year mortality in all patients (OR = 0.565, 95% CI 0.351–0.908, p=0.018) and in patients with STEMI (OR = 0.416, 95% CI 0.184–0.940, p=0.035) after adjustment. Conclusions. Among the elderly patients with ACS, the 1-year mortality rate was lower in women than in men, which could be associated with comorbidities and ACS type.

show abstract

“…On the other hand, during the follow-up period after hospital discharge, the risk for mortality was 26% lower for women in the matched angina population and similar between the sexes in the matched AMI population. Until now, inconsistent registry data has been reported regarding clinical outcomes and potential sex-related differences [13][14][15] . Compared to previous registry data, a strength of this study is its all-inclusive design; we included the entire Korean population who underwent contemporary PCI for angina or AMI 12 .…”

Section: Discussionmentioning

confidence: 99%

Sex-related impacts on clinical outcomes after percutaneous coronary intervention

Park

Han

Park

et al. 2020

Sci Rep

View full text Add to dashboard Cite

The aim of this study is to investigate sex-related impacts on clinical outcomes after percutaneous coronary intervention (PCI). We analyzed 90,305 patients (29.0% of women) with the first episode of coronary artery disease who underwent PCI from the Korean National Health Insurance claims database between July 2013 and June 2017. Women were significantly older than men (71.5 ± 10.5 vs. 61.8 ± 11.7 years, p < 0.001). The study population had a median follow-up of 2.2 years (interquartile range, 1.2–3.3). In the propensity-score matched angina population (15,104 pairs), the in-hospital mortality of women was not different from men (odds ratio, 0.87; 95% confidence interval: 0.71–1.08, p = 0.202). However, the post-discharge mortality of women was significantly lower (hazard ratio, 0.74; 95% confidence interval: 0.69–0.80, p < 0.001) than that of men. In the propensity-score matched acute myocardial infarction (AMI) population (8,775 pairs), the in-hospital mortality of women was significantly higher than that of men (odds ratio, 1.19; 95% confidence interval: 1.05–1.34, p = 0.006). Meanwhile, there was no difference in mortality after discharge (hazard ratio, 0.98; 95% confidence interval: 0.91–1.06, p = 0.605). The post-discharge mortality of women was not higher than men under the contemporary PCI treatment. Altered sex-related impacts on clinical outcomes might be attributed to improved medical and procedural strategies.

show abstract

Contemporary Sex-Based Differences by Age in Presenting Characteristics, Use of an Early Invasive Strategy, and Inhospital Mortality in Patients With Non–ST-Segment–Elevation Myocardial Infarction in the United States

Abstract: Although women were less likely to be treated with an early invasive strategy compared with men, the lower use of an early invasive strategy was not responsible for the higher crude inhospital mortality in women, which could be entirely explained by older age and higher comorbidity burden.

Cited by 54 publications

References 35 publications

Gender and age differences in outcomes of patients with acute coronary syndromes referred for coronary angiography

Gender and age differences in outcomes of patients with acute coronary syndromes referred for coronary angiography

Sex Differences in the Outcomes of Elderly Patients with Acute Coronary Syndrome

Sex-related impacts on clinical outcomes after percutaneous coronary intervention

Contact Info

Product

Resources

About