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Sex-related differences in long-term mortality and heart failure in a contemporary cohort of patients with NSTEACS. The cardiochus-HSUJ registry

  • Author Footnotes
    1 The authors contributed equally to this study. These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Belén Álvarez Álvarez
    Correspondence
    Corresponding author at: Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Travesía Choupana s/n. 15706 Santiago de Compostela, A Coruña, Spain.
    Footnotes
    1 The authors contributed equally to this study. These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Cardiology Department. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
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  • Charigan Abou Jokh Casas
    Affiliations
    Cardiology Department. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
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  • Rosa Agra Bermejo
    Affiliations
    Cardiology Department. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
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  • Alberto Cordero
    Affiliations
    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)

    Cardiology Department. Hospital Universitario de San Juan. Alicante, Spain
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  • Ana Belén Cid Álvarez
    Affiliations
    Cardiology Department. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
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  • Moisés Rodriguez Mañero
    Affiliations
    Cardiology Department. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
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  • Noelia Bouzas Cruz
    Affiliations
    Cardiology Department. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
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  • José María García Acuña
    Affiliations
    Cardiology Department. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
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  • Angel Salgado Barreiro
    Affiliations
    Methodology and Statistics unit. IDIS SUR. Vigo, Spain
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  • José R. González-Juanatey
    Affiliations
    Cardiology Department. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
    Search for articles by this author
  • Author Footnotes
    1 The authors contributed equally to this study. These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

      Highlights

      • There is insufficient data regarding sex-related differences in NSTEACS patients.
      • Women and men have similar risk regarding the development of HF hospital admissions.
      • Female sex was associated with better survival compared with their male counterparts.
      • The implementation of guidelines recommendations is accompanied by improved prognosis.

      Abstract

      Introduction and objectives

      There is insufficient data regarding sex-related prognostic differences in patients with a non-ST elevation acute coronary syndrome (NSTEACS). We performed a sex-specific analysis of cardiovascular outcomes after NSTEACS using a large contemporary cohort of patients from two tertiary hospitals.

      Methods

      This work is a retrospective analysis from a prospective registry, that included 5,686 consecutive NSTEACS patients from two Spanish University hospitals between the years 2005 and 2017. We performed a propensity score matching to obtain a well-balanced subset of individuals with the same clinical characteristics, resulting in 3,120 patients. Cox regression models performed survival analyses once the proportional risk test was verified.

      Results

      Among the study participants, 1,572 patients (27.6%) were women. The mean follow-up was 60.0 months (standard deviation of 32 months). Women had a higher risk of cardiovascular mortality compared with men (OR (Odds ratio) 1.27, CI (confidence interval) 95% 1.08-1.49), heart failure (HF) hospitalization (OR 1.39, CI 95% 1.18-1.63) and risk of all-cause mortality (OR 1.10, CI 95% 1.08-1.49). After a propensity score matching, female gender was associated with a significant reduction in the risk of total mortality (OR 0.77, CI 95% 0.65-0.90) with a similar risk of cardiovascular mortality (OR 0.86, CI 0.71-1.03) and HF hospitalization (OR 0.92, CI 95% 0.68-1.23). After baseline adjustment, the risk of all-cause mortality and cardiovascular mortality was lower in women, whereas the risk of HF remained similar among sexes.

      Conclusions

      In a contemporary cohort of patients with NSTEACS, women are at similar risk of developing early and late HF admissions, and have better survival compared with men, with a lower risk of all-cause mortality and cardiovascular mortality. The implementation of NSTEACS guideline recommendations in women, including early revascularization, seems to be accompanied by improved early and long-term prognosis.
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