Contemporary differences between men and women with acute coronary syndromes: CIAM multicenter registry

Abstract

Aim Differences exist in the diagnosis and treatment of acute coronary syndrome (ACS) between men and women. However, recent advancements in the management of ACSs might have attenuated this sex gap. We evaluated the status of ACS management in a multicenter registry in 10 tertiary Spanish hospitals. Methods We enrolled 1056 patients in our study, including only those with type 1 myocardial infarctions or unstable angina presumably not related to a secondary cause in an ‘all-comers’ design. Results The women enrolled (29%) were older than men (71.0 ± 12.8 vs. 64.0 ± 12.3, P = 0.001), with a higher prevalence of hypertension (71.0 vs. 56.5%, P < 0.001), insulin-treated diabetes (13.7 vs. 7.9%, P = 0.003), dyslipidemia (62.2 vs. 55.3%, P = 0.038), and chronic kidney disease (16.9 vs. 9.1%, P = 0.001). Women presented more frequently with back or arm pain radiation (57.3 vs. 49.7%, P = 0.025), palpitations (5.9 vs. 2.0%, P = 0.001), or dyspnea (33.0 vs. 19.4%, P = 0.001). ACS without significant coronary stenosis was more prevalent in women (16.8 vs. 8.1%, P = 0.001). There were no differences in percutaneous revascularization rates, but drug-eluting stents were less frequently employed in women (75.4 vs. 67.8%, P = 0.024); women were less often referred to a cardiac rehabilitation program (19.9 vs. 33.9%, P = 0.001). There were no significant differences in in-hospital complications such as thrombosis or bleeding. Conclusion ACS presenting with atypical symptoms and without significant coronary artery stenosis is more frequent in women. Selection of either an invasive procedure or conservative management is not influenced by sex. Cardiac rehabilitation referral on discharge is underused, especially in women.

Pharmacological Treatment After Acute Coronary Syndrome: Baseline Clinical Characteristics and Sex Differences in a Population-Based Cohort Study.

“…With regard to socio-demographic characteristics, the proportion of men and women in our study is not balanced (28.7% of women) and it is similar to previous studies. [13,14,24,25] We found that women were older, had greater comorbidity at baseline and received more comedications after the study event than men, probably because they were older when had the rst ACS, as described in a similar cohort by Ribas et al [25] In agreement with similar studies, we found a higher prevalence of comorbidities in women, [26][27][28] while men had a higher prevalence of peripheral artery disease, [29] possibly related with the higher frequency of smoking habit.…”

“…Women initiated secondary prevention less frequently than men. [12][13][14][32][33][34] Nevertheless, the majority of our population (79.5%) initiated treatment with three or four drugs combined, and almost half (47.7%) with four study drugs, although we found more women treated with ≤ two study drugs than with three or four. This may perhaps occur because physicians prescribed fewer drugs to older patients who were multimorbid and polymedicated.…”

“…Women have been reported to be older than men and have greater comorbidities, such as hypertension, diabetes and dyslipidaemia. [12][13][14][15] Some differences between sexes in secondary prevention have also been described, being women less likely to be treated. [12][13][14] This work is part of IMPACT study and the protocol has been previously published.…”

“…[12][13][14][15] Some differences between sexes in secondary prevention have also been described, being women less likely to be treated. [12][13][14] This work is part of IMPACT study and the protocol has been previously published. [16] This study aims to describe the baseline socio-demographic and clinical characteristics and the medication prescribed for secondary prevention after a rst episode of ACS in a Primary Health Care cohort in Catalonia (Spain) and to assess differences in these characteristics between women and men.…”

Pharmacological treatment after acute coronary syndrome: Baseline clinical characteristics and gender differences in a population-based cohort study

“…Women have been reported to be older than men and have greater comorbidities, such as hypertension, diabetes and dyslipidaemia. 14 , 15 , 16 , 17 Some differences between genders in secondary prevention have also been described and found that women were less likely to be treated. 14 , 15 , 16 …”