Sex differences in treatment and prognosis of acute coronary syndrome with interventional management

OBJECTIVE

Female sex has been associated with differences in diagnostic and management of acute coronary syndrome (ACS). Our aim was to analyze sex differences in ACS with interventional management in a tertiary care hospital.

METHODS

Patients with ACS admitted to a Spanish tertiary care referral center were included prospectively and consecutively. All patients included in the study underwent a coronary angiography.

RESULTS

From the total cohort of 1214 patients, 290 (24%) were women. Women were older (71 ± 12.8 vs 64 ± 13.4 years, p < 0.001) and showed lower ischemic risk and higher hemorrhagic risk scores (GRACE 159 ± 45 vs 171 ± 42, p = 0.005; CRUSADE 41 ± 19 vs 28 ± 17, p < 0.001). There were no significant differences in time to coronary angiography and revascularization rates between sex groups. A lower proportion of women received high-potency antiplatelet agents (29% vs 41.3%, p = 0.004). In-hospital evolution and one-year mortality were similar between groups.

CONCLUSIONS

In our population, there were no gender differences in management and prognosis of ACS. Differences in risk profile among groups could have an influence on antiplatelet therapy.

Influence of gender on prognosis of acute coronary syndromes

INTRODUCTION

Ischemic heart disease presents different features in men and women. We analyzed the relation between gender and prognosis in patients who had suffered a high-risk acute coronary syndrome (ACS).

METHODS

This was a prospective analytical cohort study performed at Lozano Blesa University Hospital, Zaragoza, Spain, of 559 patients diagnosed with high-risk ACS with and without ST-segment elevation according to the American College of Cardiology/American Heart Association guidelines. The sample was divided into two groups by gender and differences in epidemiologic, laboratory, electrocardiographic and echocardiographic variables and treatment were recorded. A Cox's proportional hazard model was applied and 6-month mortality was analyzed as the main variable.

RESULTS

The median age was 65.2±12.7 years, and 21.8% were women. Baseline characteristics in women were more unfavorable, with higher GRACE scores, older age, higher prevalence of hypertension, diabetes and heart failure, lower ejection fraction and more renal dysfunction at admission. Women suffered more adverse cardiovascular events (27.9% vs. 15.8%, p=0.002). Sixty-four patients died, 18.9% of the women vs. 9.4% of the men (p=0.004). After multivariate analysis, female gender did not present an independent relation with mortality. Hemoglobin level, renal function, ejection fraction and Killip class >1 presented significant differences.

CONCLUSIONS

Acute syndrome coronary in women has a worse prognosis than in men. Their adverse course is due to their baseline characteristics and not to their gender.

Ischemic heart disease in women

Nowadays, Coronary Diseases (CDs) represent the main mortality cause in men and women, but there are gender differences regarding their presentation, progression and the way the disease is tackled. This study mainly focuses on reviewing literature about the CD and its gender approach. The authors carried out a search of texts that use qualitative methodology, published between 2003 and 2009 in the following databases: PUBMED, IME, CUIDEN and CINAHL. Factors that hinder the early diagnosis of Ischemic Heart Disease in women are identified as the main findings, and the possible consequences are pointed out. In the fifty-six texts that were selected initially, we can see the difficulty women face to recognize early symptoms of the CD and their low risk perception of this disease. Greater awareness on Ischemic Heart Disease is needed, so that the high morbidity and mortality rates can be reduced.

[Acute coronary syndrome in women. Gender differences]

BACKGROUND AND OBJECTIVE

Our aims was to investigate possible gender differences in the diagnostic assessment, treatment and prognosis of patients admitted with acute coronary syndrome (ACS).

PATIENTS AND METHODS

Prospective study of a cohort of 396 patients consecutively admitted to the coronary unit in the period of 18 months with the diagnoses of ACS. We divided the sample into two groups based on gender: 294 men and 102 women. We analysed the diagnostic assessment, hospital treatment, coronary revascularization (ICP), appearance of heart failure (HF) and in-hospital and 1-year mortality. We analyzed predictors of mortality in a multivariate model.

RESULTS

Women were older (70.9±11.9 versus 64.4±12.0; P<.001) and had more comorbidities such as hypertension (70.5% versus 53.7%; P=.003), diabetes (51.0% versus 33.3%; P<.01) and HF (20.5% versus 9.1%; P<.01) than men, while men had greater frequency of smoking (54.42% versus 13.73%; P<.001). Women had higher incidence of cardiogenic shock on admission. There were no differences in thrombolysis and women did not have a different pattern of access to coronary angiography, but men had greater frequency of ICP (50.8% versus 34.6%; P<.01). Women were more likely to develop a higher in-hospital HF (32.6% versus 25.9%; P<.05) and in-hospital mortality (17.6% versus 4.7%; P<.001). In the multivariate analyses, HF on admission OR 8.98 (3.29-24.47), older age OR 1.07 (1.01-1.13) and female gender OR 3.14 (1.27-7.74), were independent predictors of in-hospital mortality.

CONCLUSIONS

In our study, female gender was an independent predictor of in-hospital mortality in patients with ACS.

Blood pressure control in hypertensive women aged 65 years or older in a primary care setting. MERICAP study

INTRODUCTION AND OBJECTIVES

The available information regarding blood pressure control in women is scarce. This study was aimed at assessing blood pressure control and predictors of a lack of blood pressure control in the primary care setting in a large sample of hypertensive women.

METHODS

Women aged 65 years or older with an established diagnosis of hypertension (≥ 6 months of evolution) were included in a cross-sectional, multicenter study. Blood pressure readings were taken following the current guidelines, and the value for each visit was the average of two separate measurements. Adequate blood pressure control was defined as < 140/90 mm Hg (< 130/80 mm Hg for diabetics).

RESULTS

A total of 4274 hypertensive women (mean age: 73.6 years [6.1 years]) were included in the study; blood pressure was controlled in 29.8% (95% confidence interval: 28.4%-31.1%) of the study population. Combined therapy was administered in 67.6% of patients (46.3% with 2 drugs and 21.7% with 3 or more drugs). The most common organ damage was left ventricular hypertrophy (33.8%) and the most common associated condition was heart failure (19%). Poor blood pressure control was more frequent in patients with more cardiovascular risk factors, organ damage, and associated clinical conditions (P<.01). A more recent hypertension diagnosis, LDL-cholesterol > 115 mg/dl, monotherapy, obesity, and hemoglobin A(1c) ≥ 7% were associated with a lack of blood pressure control (P < .0001).

CONCLUSIONS

Only 3 in 10 hypertensive women aged ≥ 65 years monitored daily in the primary care setting achieved their blood pressure goals. A recent diagnosis of hypertension was the main predictor of poor blood pressure control.