Sex-Specific Outcomes in Patients with Acute Coronary Syndrome

Abstract

<jats:p>Sex differences in patients with acute coronary syndrome (ACS) are a matter of debate. We investigated sex-specific differences in the incidence, outcomes, and related interventions in patients diagnosed with ACS in Germany over the past decade. All ACS cases from 2005 to 2015 were collected. Procedures and inhospital mortality were assessed by sex. Age-adjusted incidence rates were calculated. In total, 1,366,045 females and 2,431,501 males presenting with ACS were recorded. Females were older than males (73.1 vs. 66.4 years of age), had a longer mean hospital stay (7.7 vs. 6.9 days), and less frequently underwent coronary angiographies (55% vs. 66%) and coronary interventions (35% vs. 47%). The age-adjusted incidence rate of ACS was lower in females than in males, and decreased in both sexes from 2005 to 2015. The age-adjusted inhospital mortality rate was substantially higher in females than in males, but decreased in both sexes over time (in females, from 87 to 71 cases per 1000 person years; in males, from 57 to 51 cases per 1000 person years). In conclusion, we reported sex differences in the incidence, treatment, and outcomes of ACS patients in Germany within the past decade. Women had a substantially higher mortality rate and lower rate of coronary interventions.</jats:p>

Sex differences in long-term outcomes in older adults undergoing invasive treatment for non-ST elevation acute coronary syndrome: An ICON-1 sub-study

“…Studies have suggested that a more atypical symptom presentation among females is associated with a delay in appropriate treatment provision [25] , [26] , and females with early menopause are at increased risk of cardiovascular disease before the age of 70 years [27] . Additionally, and in contrast to our study, previous studies report that females less frequently undergo revascularisation for ACS than males [13] , [28] . The lower provision of invasive treatments in females with NSTEACS compared to males is contrary to clinical guidelines that do not distinguish between males and females in terms of treatment strategy [16] .…”

Sex Differences in Acute Coronary Syndromes: A Global Perspective

“…Similar to the Americas, large registries from Western Europe reflect excess mortality and persistent sex-based differences in ACS care among women, with less GDMT and invasive revascularization procedures [ 6 , 14 , 137 , 138 , 139 , 140 ]. Furthermore, reperfusion strategies in women less frequently involved radial access [ 4 , 6 , 14 ], thrombo-aspiration [ 14 ] and drug-eluting stent (DES) implantation [ 139 ].…”

Sex Differences in the Incidence and Outcomes of Acute Myocardial Infarction in Spain, 2016–2018: A Matched-Pair Analysis

“…Indeed, some authors have described a sex–age interaction effect that could explain the worse outcomes initially seen for younger women after MI [ 3 ]. Subsequent research pointed to the fact that women received invasive therapies less often, mainly at advanced ages, and this distinct management seemed to account for the differences found in short-term mortality [ 4 , 5 ]. Very recently, Alkhouli M et al, using the Nationwide Inpatient Sample (NIS), analyzed sex-differences in the incidence and outcomes of ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI), with data of a total of 6,720,639 weighted hospitalizations from 2001 to 2015 in the United States.…”