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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Article info
Publication history
Published online: June 18, 2020
Accepted:
June 10,
2020
Received in revised form:
May 31,
2020
Received:
April 2,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
