Influence of Gender on Long-Term Mortality in Patients Presenting With Non–ST-Elevation Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

Study Questions:

Does invasive management of women admitted with non–ST-elevation acute coronary syndromes (NSTE-ACS) reduce long-term adverse events?

Methods:

Consecutive patients presenting at the Cleveland Clinic (Cleveland, OH) from March 2003 through June 2007 who underwent index percutaneous coronary intervention (PCI) were included in the registry. Patients admitted with ST-segment elevation myocardial infarction (STEMI) or elective PCI were excluded; thus, only patients with NSTEMI or unstable angina were included in the present analysis. The primary outcomes of interest were in-hospital and long-term mortality. The mean duration of follow-up was 2.1 years. Step-wise regression was used to identify risk factors for long-term mortality with gender forced into the final model. Possible interaction between gender and age, and gender and biomarker status, was also explored.

Results:

A total of 1,874 patients (1,117 men and 697 women) were included, of which 805 (43%) presented with NSTEMI, and 1,069 (57%) presented with unstable angina. There was no gender difference in prevalence of positive biomarkers. Women were older and more likely to have diabetes, chronic obstructive pulmonary disease, obesity, and anemia. During the follow-up (mean 2.1 years), a total of 182 deaths occurred. There was no overall difference in in-hospital (1.4% vs. 1.6%) or long-term (14.6% vs. 15.8%) mortality between men and women. However, women under the age of 60 years had greater mortality compared to men, in particular those who were troponin negative (15% vs. 7.4%, p = 0.003).

Conclusions:

The investigators concluded that overall death rates are similar for men and women admitted with NSTEMI or unstable angina. However, younger women with unstable angina appear to have an increased risk for death.

Perspective:

These data suggest that younger women presenting with heart disease represent a high-risk cohort. Understanding the implications of traditional risk factors in young women may have important management implications to lowering mortality in this group. In addition, there is potential for novel risk factors, which may be relevant in young women; such factors may not have been found, as these patients are often not well represented in ACS studies.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, ACS and Cardiac Biomarkers, Implantable Devices, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Myocardial Infarction, Acute Coronary Syndrome, Follow-Up Studies, Heart Conduction System, Intracellular Signaling Peptides and Proteins, Risk Factors, Percutaneous Coronary Intervention, Heart Diseases, Pulmonary Disease, Chronic Obstructive, Biological Markers, Coronary Angiography, Obesity, Diabetes Mellitus, Troponin


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