Gender Characteristics and Outcome After Acute Coronary Syndrome in the Young

Study Questions:

Are gender characteristics associated with adverse events after acute coronary syndrome (ACS)?


Data from the GENESIS-PRAXY (GENdEr and Sex determinantS of cardiovascular disease; from bench to beyond-Premature Acute Coronary Syndrome) study, a prospective observational cohort with participants enrolled between January 2009 and April 2013, were used in this multicenter study. Men and women between the ages of 18 and 55 years who experienced an ACS event from 24 centers in Canada, one in the US, and one in Switzerland, were recruited within 24 hours for admission. Information on gender roles (e.g., social roles) was collected through self-administered questionnaires, from which a composite measure of gender was derived. Primary outcomes of interest included recurrent ACS and major adverse cardiac events (MACE; ACS, cardiac mortality, revascularization) over a 12-month follow-up period.


A total 273 (30%) women and 636 (70%) men were included in the study. The mean gender-related score was 30.5 and the median age was 48 years. Recurrent ACS at 12 months was 3% (35), and 8% (75) experienced MACE. A total of 9 (<1%) participants in the cohort died during the follow-up. No difference in rate of recurrent ACS, MACE, or death between male and female sex was noted. Feminine roles and personality traits were associated with increased rates for recurrent ACS and MACE as compared to masculine characteristics. After adjustment for potential confounders, feminine gender traits remained independently associated with recurrent ACS (hazard ratio [HR], 4.50; 95% confidence interval [CI], 1.05-19.27) for a score of 0-100. A nonsignificant trend was observed for MACE (HR, 1.54; 95% CI, 0.90-2.66). Increased anxiety was the only condition that was both more prevalent in patients with feminine characteristics and which rendered the association between gender and recurrent ACS nonstatistically significant (HR, 3.56; 95% CI, 0.81-15.61). Female sex was not associated with post-ACS outcomes.


The investigators concluded that among younger adults who experience ACS, feminine gender is associated with an increased risk for recurrent ACS in the following 12-month post event, and these gender characteristics are independent of female sex.


Often studies simply examine outcomes by sex and an indepth analysis along gender roles is not conducted. These data support the need to examine both sex and gender. Further research is warranted to understand gender characteristics and develop interventions that may reduce recurrent cardiac events.

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

Keywords: Acute Coronary Syndrome, Anxiety, Female, Mortality, Myocardial Revascularization, Outcome Assessment (Health Care), Risk, Sex Characteristics

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