Temporal Trends Analysis of the Characteristics, Management, and Outcomes of Women With Acute Coronary Syndrome (ACS): ACS Israeli Survey Registry 2000‐2016

Abstract

Background Cardiovascular disease remains a leading cause of death among women. Despite improvements in the management of patients with acute coronary syndrome ( ACS ), women with an ACS remain at higher risk. Methods and Results We performed a time‐dependent analysis of the management and outcomes of women admitted with ACS who enrolled in the prospective biennial ACS Israeli Surveys between 2000 and 2016. Surveys were divided into 3 time periods (2000‐2004, 2006‐2010, and 2013‐2016). Outcomes included 30‐day major adverse cardiac events (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1‐year mortality. Overall, 3518 women were admitted with an ACS . Their mean age (70±12 years) was similar among the time periods. Over the time course of the study, more women were admitted with non– ST ‐elevation ACS (51.9%, 59.6%, and 66.1%, respectively; P <0.001), and statins and percutaneous coronary intervention were increasingly utilized (66%, 91%, 93%, and 42%, 60%, and 68%, respectively; P <0.001 for each). Among women with ST ‐segment–elevation myocardial infarction, more primary percutaneous coronary interventions were performed (48.5%, 84.7%, and 95.3%, respectively; P <0.001). The rate of 30‐day major adverse cardiac events has significantly decreased over the years (24.6%, 18.6%, and 13.5%, respectively; P <0.001). However, 1‐year mortality rates declined only from 2000 to 2004 (16.9%, 12.8%, and 12.3%; P =0.007 for the overall difference), and this change was not significant after propensity matching or multivariate analysis. Conclusions Over more than a decade, 30‐day major adverse cardiac events have decreased among women with ACS . Advances in pharmacological treatments and an early invasive approach may have accounted for this improvement. However, the lack of further reduction in 1‐year mortality rates among women suggests that more measures should be provided in this high‐risk population.

Clinical Features and Prognoses of Middle-Aged Women With ST-Elevation Myocardial Infarction With a Focus on Spontaneous Coronary Artery Dissection

“…Further, what should constitute the appropriate management of ST-elevation myocardial infarction (STEMI) in women has yet to be elucidated given the variety in pathophysiological processes, the possible extension of the dissection, the propagation of aortic intramural hematomas, and possible poor outcomes during percutaneous coronary intervention (PCI), while these patients continue to have poorer clinical outcomes and higher rates of in-hospital complications and mortality. [6][7][8] Such concerns regarding PCI in SCAD patients, conservative treatments have been preferred in a substantial body of literature. 6,8,9 Due to considerable concerns about over patients with SCAD in the setting of STEMI (STEMI-SCAD), we conducted the present study to identify the clinical features and prognoses of SCAD in middle-aged women presenting with STEMI.…”

Coronary Artery Disease in Women: A Comprehensive Appraisal

“…Mechanical complications and subsequent heart failure are more likely to develop in women after an acute myocardial infarction [2]. Encouragingly, there is evidence to show that over the last 20 years, the rate of 30-day major adverse cardiac events and in-hospital complications amongst women with the acute coronary syndrome is decreasing [80].…”

Sex-related risk of heart failure in suspected or known coronary artery disease: adding a piece to the puzzle

“…Studies have shown that despite the advanced treatment options of coronary artery disease (CAD), women that have suffered a myocardial infarction (MI) carry a higher risk of mortality and recurrent MI and have surprisingly lower rates of revascularisation after an acute event compared to their male counterparts [5][6][7] . Additionally, it has been demonstrated that women are at higher risk of developing heart failure following an acute MI, regardless of the severity of the coronary artery disease as determined by invasive angiography 5 .…”