OBJECTIVES: The purpose of this research was to determine if sex and gender differences in the management of acute coronary syndromes (ACS) are associated with differences in prognosis after ACS. BACKGROUND: Previous investigators have reported sex/gender differences in the management of patients with ACS, but the impact of these differences on prognosis is unclear. METHODS: We analyzed data from the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial, which enrolled 4,836 women and 7,726 men with ACS. Patients were classified into risk strata using the Thrombolysis In Myocardial Infarction (TIMI) score. RESULTS: Women underwent fewer invasive procedures including angiography, angioplasty, and coronary artery bypass graft (CABG) surgery (47.6% vs. 60.5%; p = 0.0001) compared to men. No significant differences in cardiovascular death, myocardial infarction (MI), or stroke were observed (9.8% vs. 10.9%; p = 0.04), although women were more likely than men to develop refractory ischemia and to be rehospitalized for chest pain during follow-up (16.6% vs. 13.9%; p = 0.0001). These differences were particularly evident among TIMI high-risk women. A significant interaction between TIMI risk and gender for the outcome of refractory angina and rehospitalization for angina was present. CONCLUSIONS: Compared to men, high-risk women with ACS undergo less coronary angiography, angioplasty, and CABG surgery, and while they do not have higher incidence cardiovascular death, recurrent MI, or stroke, they suffer an increased rate of refractory ischemia and rehospitalization. All high-risk women and men with ACS should receive optimal medical management, and be considered for coronary angiography with possible revascularization if their coronary anatomy warrants it.
OBJECTIVES: The purpose of this research was to determine if sex and gender differences in the management of acute coronary syndromes (ACS) are associated with differences in prognosis after ACS. BACKGROUND: Previous investigators have reported sex/gender differences in the management of patients with ACS, but the impact of these differences on prognosis is unclear. METHODS: We analyzed data from the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial, which enrolled 4,836 women and 7,726 men with ACS. Patients were classified into risk strata using the Thrombolysis In Myocardial Infarction (TIMI) score. RESULTS:Women underwent fewer invasive procedures including angiography, angioplasty, and coronary artery bypass graft (CABG) surgery (47.6% vs. 60.5%; p = 0.0001) compared to men. No significant differences in cardiovascular death, myocardial infarction (MI), or stroke were observed (9.8% vs. 10.9%; p = 0.04), although women were more likely than men to develop refractory ischemia and to be rehospitalized for chest pain during follow-up (16.6% vs. 13.9%; p = 0.0001). These differences were particularly evident among TIMI high-risk women. A significant interaction between TIMI risk and gender for the outcome of refractory angina and rehospitalization for angina was present. CONCLUSIONS: Compared to men, high-risk women with ACS undergo less coronary angiography, angioplasty, and CABG surgery, and while they do not have higher incidence cardiovascular death, recurrent MI, or stroke, they suffer an increased rate of refractory ischemia and rehospitalization. All high-risk women and men with ACS should receive optimal medical management, and be considered for coronary angiography with possible revascularization if their coronary anatomy warrants it.
Authors: Rachel P Dreyer; Kumar Dharmarajan; Kevin F Kennedy; Philip G Jones; Viola Vaccarino; Karthik Murugiah; Sudhakar V Nuti; Kim G Smolderen; Donna M Buchanan; John A Spertus; Harlan M Krumholz Journal: Circulation Date: 2017-02-07 Impact factor: 29.690
Authors: Alice M Jackson; Ruiqi Zhang; Iain Findlay; Keith Robertson; Mitchell Lindsay; Tamsin Morris; Brian Forbes; Richard Papworth; Alex McConnachie; Kenneth Mangion; Pardeep S Jhund; Colin McCowan; Colin Berry Journal: Eur Heart J Qual Care Clin Outcomes Date: 2020-04-01
Authors: Rachel P Dreyer; Kumar Dharmarajan; Angela F Hsieh; John Welsh; Li Qin; Harlan M Krumholz Journal: Circ Cardiovasc Qual Outcomes Date: 2017-05
Authors: Petra Hillinger; Raphael Twerenbold; Karin Wildi; Maria Rubini Gimenez; Cedric Jaeger; Jasper Boeddinghaus; Thomas Nestelberger; Karin Grimm; Tobias Reichlin; Fabio Stallone; Christian Puelacher; Zaid Sabti; Nikola Kozhuharov; Ursina Honegger; Paola Ballarino; Oscar Miro; Kris Denhaerynck; Temizel Ekrem; Claudia Kohler; Roland Bingisser; Stefan Osswald; Christian Mueller Journal: Clin Res Cardiol Date: 2016-07-12 Impact factor: 5.460
Authors: Markus Bönte; Olaf von dem Knesebeck; Johannes Siegrist; Lisa Marceau; Carol Link; Sara Arber; Ann Adams; John B McKinlay Journal: Womens Health Issues Date: 2008 May-Jun
Authors: Rikke Sørensen; G H Gislason; E L Fosbøl; S Rasmussen; L Køber; J K Madsen; C Torp-Pedersen; S Z Abildstrom Journal: Br J Clin Pharmacol Date: 2008-09-23 Impact factor: 4.335