Roberta De Rosa1, Nuccia Morici2, Giuseppe De Luca3, Leonardo De Luca4, Luca A Ferri5, Luigi Piatti6, Giovanni Tortorella7, Daniele Grosseto8, Nicoletta Franco8, Leonardo Misuraca9, Paolo Sganzerla10, Michele Cacucci11, Roberto Antonicelli12, Claudio Cavallini13, Laura Lenatti6, Chiara Leuzzi14, Ernesto Murena15, Amelia Ravera16, Maurizio Ferrario17, Elena Corrada18, Delia Colombo19, Francesco Prati20, Federico Piscione16, A Sonia Petronio21, Gennaro Galasso16, Stefano De Servi22, Stefano Savonitto23. 1. University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy; Goethe University Hospital Frankfurt, Frankfurt am Main, Germany. 2. ASST Grande Ospedale Metropolitano Niguarda, Milan; Department of Clinical Sciences and Community Health, Università degli Studi di Milo, Milan, Italy. 3. Azienda Ospedaliera Universitaria Maggiore della Carità, Eastern Piedmont University, Novara, Italy. 4. Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy. 5. San Raffaele Scientific Institute, Milan, Italy. 6. Manzoni Hospital, Lecco, Italy. 7. Ospedale Vaio, Fidenza, Italy. 8. Ospedale Infermi, Rimini, Italy. 9. Ospedale della Misericordia, Grosseto, Italy. 10. ASST Bergamo ovest-ospedale di Treviglio, Treviglio, Italy. 11. Ospedale Maggiore, Crema, Italy. 12. IRCCS Istituto Nazionale di Ricerca e Cura per l'Anziano, Ancona, Italy. 13. Ospedale S. Maria della Misericordia, Perugia, Italy. 14. IRCCS Arcispedale S. Maria Nuova, Reggio Emilia. 15. Ospedale S. Maria delle Grazie, Pozzuoli, Italy. 16. University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy. 17. IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy. 18. Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy. 19. Clinical Pharmacology, Milan, Italy. 20. Ospedale S. Giovanni-Addolorata, Roma, Italy. 21. Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. 22. University of Pavia, Italy. 23. Manzoni Hospital, Lecco, Italy. Electronic address: s.savonitto@asst-lecco.it.
Abstract
BACKGROUND: Worse outcomes have been reported for women, compared with men, after an acute coronary syndrome (ACS). Whether this difference persists in elderly patients undergoing similar invasive treatment has not been studied. We investigated sex-related differences in 1-year outcome of elderly acute coronary syndrome patients treated by percutaneous coronary intervention (PCI). METHODS: Patients 75 years and older successfully treated with PCI were selected among those enrolled in 3 Italian multicenter studies. Cox regression analysis was used to assess the independent predictive value of sex on outcome at 12-month follow-up. RESULTS: A total of 2035 patients (44% women) were included. Women were older and most likely to present with ST-elevation myocardial infarction (STEMI), diabetes, hypertension, and renal dysfunction; men were more frequently overweight, with multivessel coronary disease, prior myocardial infarction, and revascularizations. Overall, no sex disparity was found about all-cause (8.3% vs 7%, P = .305) and cardiovascular mortality (5.7% vs 4.1%, P = .113). Higher cardiovascular mortality was observed in women after STEMI (8.8%) vs 5%, P = .041), but not after non ST-elevation-ACS (3.5% vs 3.7%, P = .999). A sensitivity analysis excluding patients with prior coronary events (N = 1324, 48% women) showed a significantly higher cardiovascular death in women (5.4% vs 2.9%, P = .025). After adjustment for baseline clinical variables, female sex did not predict adverse outcome. CONCLUSIONS: Elderly men and women with ACS show different clinical presentation and baseline risk profile. After successful PCI, unadjusted 1-year cardiovascular mortality was significantly higher in women with STEMI and in those with a first coronary event. However, female sex did not predict cardiovascular mortality after adjustment for the different baseline variables.
BACKGROUND: Worse outcomes have been reported for women, compared with men, after an acute coronary syndrome (ACS). Whether this difference persists in elderly patients undergoing similar invasive treatment has not been studied. We investigated sex-related differences in 1-year outcome of elderly acute coronary syndromepatients treated by percutaneous coronary intervention (PCI). METHODS:Patients 75 years and older successfully treated with PCI were selected among those enrolled in 3 Italian multicenter studies. Cox regression analysis was used to assess the independent predictive value of sex on outcome at 12-month follow-up. RESULTS: A total of 2035 patients (44% women) were included. Women were older and most likely to present with ST-elevation myocardial infarction (STEMI), diabetes, hypertension, and renal dysfunction; men were more frequently overweight, with multivessel coronary disease, prior myocardial infarction, and revascularizations. Overall, no sex disparity was found about all-cause (8.3% vs 7%, P = .305) and cardiovascular mortality (5.7% vs 4.1%, P = .113). Higher cardiovascular mortality was observed in women after STEMI (8.8%) vs 5%, P = .041), but not after non ST-elevation-ACS (3.5% vs 3.7%, P = .999). A sensitivity analysis excluding patients with prior coronary events (N = 1324, 48% women) showed a significantly higher cardiovascular death in women (5.4% vs 2.9%, P = .025). After adjustment for baseline clinical variables, female sex did not predict adverse outcome. CONCLUSIONS: Elderly men and women with ACS show different clinical presentation and baseline risk profile. After successful PCI, unadjusted 1-year cardiovascular mortality was significantly higher in women with STEMI and in those with a first coronary event. However, female sex did not predict cardiovascular mortality after adjustment for the different baseline variables.
Authors: Hanna Ratcovich; Mohammad Alkhalil; Benjamin Beska; Lene Holmvang; Mike Lawless; I Gede Dennis Sukadana; Chris Wilkinson; Vijay Kunadian Journal: Int J Cardiol Heart Vasc Date: 2022-09-06