Sex-Related Outcomes in Acute Coronary Syndrome | Journal Scan

Study Questions:

What are the sex-related differences in treatment and outcomes in elderly patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS)?


The Italian Elderly ACS study enrolled NSTE-ACS patients aged ≥75 years in a randomized trial comparing an early aggressive with an initially conservative strategy, and in a registry of patients with ≥1 exclusion criteria of the trial. The investigators compared sexes in the pooled populations of the trial and registry. The primary endpoint was the composite of all-cause mortality, nonfatal myocardial infarction (MI), disabling stroke, and repeat hospitalization for cardiovascular causes or severe bleeding within 12 months.


A total of 645 patients (313 from the trial and 332 from the registry), including 301 women (47%), were enrolled. Women were slightly older than men (82.1 ± 5.0 vs. 81.2 ± 4.5 years; p = 0.02), had lower hemoglobin levels (12.5 ± 1.6 vs. 13.3 ± 1.9 g/dl, p < 0.001), and underwent fewer coronary revascularizations during the index admission (37.2% vs. 45.0%; p = 0.04). In-hospital adverse event rates were similar in both sexes; severe bleeding was uncommon (0.3% vs. 0%). The 1-year primary endpoint (composite of death, nonfatal MI, disabling stroke, cardiac rehospitalization, and severe bleeding) occurred less often in women (27.6% vs. 38.7%; p < 0.01). Women not undergoing revascularization showed a threefold higher mortality, both in-hospital (8.5% vs. 2.7%; p = 0.05) and at 1 year (21.6% vs. 8.1%; p = 0.002).


The authors concluded that elderly women had a similar in-hospital outcome and better 1-year outcome compared with men.


This study reports that coronary revascularization is still performed significantly less often in women post–NSTE-ACS, and women who are not revascularized have a threefold higher in-hospital and 1-year mortality rate compared with revascularized women. It appears reasonable to consider revascularization as the preferred option for elderly women with an NSTE-ACS to improve outcomes. Overall, women with an NSTE-ACS should receive the same diagnostic and therapeutic approach as their male counterparts, assuming similar coronary anatomy.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Interventions and ACS

Keywords: Acute Coronary Syndrome, Female, Aged, Geriatrics, Hemoglobins, Hemorrhage, Hospitalization, Mortality, Myocardial Infarction, Myocardial Revascularization, Primary Prevention, Registries, Stroke

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