Sex Differences in Mortality Following Acute Coronary Syndromes

Abstract

ARDIOVASCULAR DISEASE IS THE leading cause of death in both men and women, accounting for one-third of all deaths. 1 Although several studies have shown an improvement of prognosis in women over time, 2 overall outcomes remain worse for women compared with men, 3 providing a strong rationale for focusing on the study of sex-based differences in the outcome of acute coronary syndromes (ACS). Previous analyses of sex-based differences following ACS have reported conflicting results, even after adjustment for demographics and clinical characteristics. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] In a large systematic review comparing short-term mortality between women and men, Vaccarino et al 3 concluded that after adjustment for differences in age and baseline prognostic factors, some but not all of the excess mortality was explained.Several studies have offered novel approaches to understanding sexbased differences following ACS. 14,[18][19][20][21] A large cohort analysis from the National Registry of Myocardial Infarction demonstrated a higher risk of early death for younger but not older women. 14 A prior analysis from the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO IIb) 22 found that women and men have outcomes that differ according to the type of ACS.

Outcomes of Women and Men With Acute Coronary Syndrome Treated With and Without Percutaneous Coronary Revascularization

“…The current findings add to the literature of previously reported sex‐based differences in outcomes following myocardial infarction,1, 2, 3, 4 and suggest that sex differences in outcomes remain among patients who undergo early revascularization 30. While we cannot identify the exact reason underlying these differences, several potential hypotheses could be discounted.…”

“…Women hospitalized with an acute coronary syndrome (ACS) are at a higher risk for adverse outcomes as compared to men 1, 2, 3, 4. Extensive evaluations have suggested that these discrepancies are multifactorial 5.…”

“…Extensive evaluations have suggested that these discrepancies are multifactorial 5. They are partly explained by clinical differences where women with ACS are older at presentation, have a higher burden of comorbidities, and tend to present later and with more atypical symptoms compared with men 3, 6, 7, 8, 9, 10. In addition, there are sex‐based differences in the primary and secondary treatment of coronary disease 11, 12, 13.…”

Stress Cardiac MRI in Women With Myocardial Infarction and Nonobstructive Coronary Artery Disease

“…[1][2][3] Although patients with MI with obstructive coronary artery disease (CAD) carry a worse prognosis, the rate of death and reinfarction in patients with MI and nonobstructive CAD on angiography (MINOCA) is 2% to 5%. [4][5][6][7][8][9][10][11][12] Mechanisms are incompletely understood, leading to uncertainty about treatment.…”

Influence of Ethnicity, Age, and Time on Sex Disparities in Long‐Term Cause‐Specific Mortality After Acute Myocardial Infarction

“…Studies have identified that women have higher all‐cause mortality than men following acute myocardial infarction (AMI) 1, 2, 3, 4, 5, 6. These studies have consistently shown that women are, on average, 10 years older at presentation; have a higher burden of comorbidities; and are less likely to receive up‐to‐date treatment, including reperfusion therapy, than men 7.…”