Prognostic Differences between Men and Women with Acute Coronary Syndrome. Data from a Brazilian Registry

Abstract

BackgroundGender-related differences have been reported in patients with acute coronary syndrome. The description of this comparative finding in a Brazilian registry has not yet been documented.ObjectiveTo compare male vs. female patients regarding the baseline characteristics, coronary findings, treatment and in-hospital and long-term prognosis.MethodsThis is a retrospective, multicenter and observational study that included 3,745 patients (2,437 males and 1,308 females) between May 2010 and May 2015. The primary in-hospital outcome was all-cause mortality. The secondary outcome consisted of combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed using the chi-square and the t test, considering p < 0.05 as significant. In the long term, mortality and combined events were assessed using the Kaplan-Meier method, with a mean follow-up of 8.79 months.ResultsThe mean age was 60.3 years for males and 64.6 for females (p < 0.0001). The most prevalent risk factor was systemic arterial hypertension in 72.9% of the women and 67.8% of the men (p = 0.001). Percutaneous coronary intervention was carried out in 44.9% of the males and 35.4% of the females (p < 0.0001), and coronary artery bypass grafting (CABG) was performed in 17% of the males and 11.8% of females (p < 0.0001), with a higher prevalence of three-vessel coronary artery disease in males (27.3% vs. 16.2%, p < 0.0001). Approximately 79.9% of the female patients received a diagnosis of acute coronary syndrome without ST-segment elevation, while in the male patients, this diagnosis was attained in 71.5% (p < 0.0001). No significant differences were observed between the groups in the short and long term, regarding both mortality and the combined events.ConclusionSeveral gender-related differences were observed in patients with acute coronary syndrome regarding the demographic characteristics, coronary artery disease pattern and implemented treatment. However, the prognostic evolution was similar between the groups.

Akut Koroner Sendrom Geçiren Hastalarda Risk Faktörlerinin Belirlenmesi

“…Bu çalışmayla bulgular benzerlik göstermektedir. Soeiro ve ark., [15] ise AKS geçiren hastaların yaş ortalamasını, erkeklerde 60.3±11.6, kadınlarda 64.6±10.4 olarak bildirmiştir. Soeiro ve ark., [15] daha ileri yaşlarda AKS saptanmışken; bizim çalışmamızda AKS yaşının 10 yaş daha düşük olduğu bulundu.…”

“…Soeiro ve ark., [15] ise AKS geçiren hastaların yaş ortalamasını, erkeklerde 60.3±11.6, kadınlarda 64.6±10.4 olarak bildirmiştir. Soeiro ve ark., [15] daha ileri yaşlarda AKS saptanmışken; bizim çalışmamızda AKS yaşının 10 yaş daha düşük olduğu bulundu. Bu çalışmada risk faktörlerini doğru tanımlayabilmek amacıyla ilk kez AKS geçiren hastalar örnekleme alınırken, Soeiro ve ark., [15] [6] Bu bilgiden ve çalışmanın verilerinden yola çıkarak düşük gelir düzeyinin AKS geçirmede risk faktörü olduğu düşünüldü.…”

“…Bulgular bu çalışmayla benzerlik göstermektedir. Soeiro ve ark., [15] Brezilya'da AKS'lu 3.745 hastada (2.437 erkek ve 1.308 kadın) yaptıkları retrospektif, çok merkezli çalışmada kadınların beden kitle indeksini, erkeklere oranla düşük bulmuşlardır (p<0.001). Bu çalışmayla farklı sonuçlar elde edilmesinin kültürel özelliklerin farklı olmasına bağlı olduğu düşünüldü.…”

Gender Disparities and Outcomes Of Acute Coronary Syndromes In Brazil

“… 4 In the last decade, several studies have assessed the issue of gender disparities in the diagnosis, treatment, and outcomes of acute coronary syndromes (ACS). 2 , 4 In this context, the study by Soeiro et al 5 contributes to the understanding of this issue by presenting data from a Brazilian registry of ACS.…”

Equidade entre Sexos no Acesso à Reperfusão no Infarto Agudo do Miocárdio: Um Longo Caminho a ser Percorrido

“…Ischemic heart disease is the main cause of death worldwide, and its most severe presentation ST-elevation acute myocardial infarction (STEMI), which corresponds to approximately 1/3 of the presentations, 1 and early reperfusion is the main strategy for reducing mortality. Despite broad historical knowledge of gender-related differences in treatment and prognosis of patients with an acute presentation of ischemic heart disease, male individuals, in addition to having earlier access to health systems, are even more likely to undergo a diagnostic coronary angiography and urgent revascularization than women.…”