249 Sex-related differences in the treatment and outcomes of canadian acute coronary syndrome patients over the past decade

Systematic Review and Individual Patient Data Meta-Analysis of Sex Differences in Depression and Prognosis in Persons With Myocardial Infarction

“…That depression was more strongly related to prognosis for men may be explained by the differential nature of MI in women and men. Women with MI tend to be older by approximately 10 years, have more diffuse coronary disease, have non-STelevation MI thereby not being eligible for emergency primary percutaneous coronary intervention (26) which is protective of subsequent lowering of LVEF (27)(28)(29), and therefore have worse hospital outcomes (26,27). Men tend to have more focal lesions that result in ST-elevation MI.…”

“…In the current data, women were less likely to receive percutaneous coronary intervention. As a result, women are more likely to end up with heart failure with preserved ejection fraction while men end up with heart failure with reduced ejection fraction (27)(28)(29). Thus, the differential attenuation by LVEF of the association of depression with outcomes may be partly explained by the fact that women are less likely to have the type of MI that results in a low LVEF.…”

“…The major strength of the study is the use of individual patient data, which allows for time-to-event analysis, and adjustment for potentially confounding variables systematically across studies, which cannot be done in summary meta-analyses, resulting in more accurate estimates of effect sizes, increased statistical power, generalizability and reliability of results (39). The inclusion of the random intercept term allows important between-study differences to be accounted for statistically, such as changing acute treatments (percutaneous coronary intervention has superseded thrombolysis in the timeframe spanned by the present studies) (27,28), or differential assessment of LVEFwhich may impact on its prognostic ability (40,41). The ability to analyse both interview and questionnaire studies is a strength, and the results demonstrated consistent patterns across these methods.…”

Acute coronary syndrome : bleeding, platelets and gender

“…These differences have remained the same for the last decade, women are treated with less interventions and have a higher mortality in-hospital. (146) In paper III we found that women are more prone to early withdrawal of antithrombotic medication, most often because of bleeds. This is consistent with previous findings from registries where female sex was linked to lower long-term adherence to aspirin, ACE-inhibitors and lipid lowering agents, (147) as well as to antiplatelet agents in patients undergoing PCI.…”