(Ivanhoe Newswire) -- Women may have a slightly higher risk of death
than men in the 30 days following an acute coronary syndrome (ACS) such as
heart attack or unstable angina, according to a new study.
Cardiovascular disease is the leading cause of death in both men and women,
accounting for one-third of all deaths. Although several studies have shown
an improvement of prognosis in women over time, overall outcomes remain
worse for women compared with men, providing a strong rationale for focusing
on the study of sex-based differences in the outcome of ACS.
Jeffrey S. Berger, M.D., M.S., of the New York University School of Medicine
and colleagues evaluated the relationship between gender and 30-day
mortality following ACS. They analyzed factors such as clinical
classification at the time of ACS and the severity of angiographic disease.
Patients for the study were pooled from a sample of 11 independent,
international, randomized ACS clinical trials between 1993 and 2006.
Of the 136,247 patients in this analysis, 28 percent were women. There were
102,004 patients (26 percent women) with ST-segment elevation myocardial
infarction (STEMI, a certain pattern on an electrocardiogram following a
heart attack); 14,466 with non-STEMI (29 percent women); and 19,777 with
unstable angina (40 percent women). Women were older and had a higher
prevalence of hypertension, hyperlipidemia, diabetes and heart failure. Men
were more likely to be smokers and had a higher prevalence of prior heart
attack and prior coronary artery bypass graft surgery.
"Perhaps the most striking findings in our analyses relate to the
examination of mortality according to type of ACS. We found a significant
interaction between sex and type of ACS, such that 30-day mortality risk
among women was modestly higher than men only for those patients presenting
with STEMI. In patients with NSTEMI and unstable angina, women had a lower
adjusted 30-day mortality risk than men. In fact, the strongest finding
after full adjustment was lower risk among women with unstable angina," the
authors write.
The researchers also found that women who underwent catheterization were
more likely than men to have non-obstructive coronary artery disease and
less likely to have multi-vessel disease. The relationship between gender
and 30-day mortality was similar across the levels of angiographic disease
severity.
"Sex-based differences exist in 30-day mortality among patients with ACS and
vary depending on clinical presentation. However, these differences are
markedly attenuated following adjustment for clinical differences and
angiographic data,” the researchers concluded. “Understanding and
considering these differences may lead to better risk stratification and
treatment of all patients with ACS."
SOURCE: Journal of the American Medical Association (JAMA), August 26, 2009
