ACUTE CORONARY SYNDROMES

Gender differences in management and outcome in non-ST-elevation acute coronary syndrome

Joakim Alfredsson¹, Ulf Stenestrand¹, Lars Wallentin², Eva Swahn¹

¹ Department of Medicine and Care, Division of Cardiology, University Hospital, Linköping, Sweden
² Uppsala Clinical Research Center, Uppsala University, Sweden

Joakim Alfredsson, Department of Medicine and Care, Division of Cardiology, Linköping University Hospital, SE 581 85 Linköping, Sweden; joakim.alfredsson{at}imv.liu.se

Objective: To study gender differences in management and outcome in patients with non-ST-elevation acute coronary syndrome.

Design, setting and patients: Cohort study of 53 781 consecutive patients (37% women) from the Register of Information and Knowledge about Swedish Heart Intensive care Admissions (RIKS-HIA), with a diagnosis of either unstable angina pectoris or non-ST-elevation myocardial infarction. All patients were admitted to intensive coronary care units in Sweden, between 1998 and 2002, and followed for 1 year.

Main outcome measures: Treatment intensity and in-hospital, 30-day and 1-year mortality.

Results: Women were older (73 vs 69 years, p<0.001) and more likely to have a history of hypertension and diabetes, but less likely to have a history of myocardial infarction or revascularisation. After adjustment, there were no major differences in acute pharmacological treatment or prophylactic medication at discharge.

Revascularisation was, however, even after adjustment, performed more often in men (OR 1.15; 95% CI, 1.09 to 1.21). After adjustment, there was no significant difference in in-hospital (OR 1.03; 95% CI, 0.94 to 1.13) or 30-days (OR 1.07; 95% CI, 0.99 to 1.15) mortality, but at 1 year being male was associated with higher mortality (OR 1.12; 95% CI, 1.06 to 1.19).

Conclusion: Although women are somewhat less intensively treated, especially regarding invasive procedures, after adjustment for differences in background characteristics, they have better long-term outcomes than men.

Abbreviations: CRUSADE, Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines; FRISC II, FRagmin and fast revascularisation during InStability in Coronary artery disease; ICTUS, Invasive versus Conservative Treatment in Unstable coronary Syndromes; RIKS-HIA, Register of Information and Knowledge about Swedish Heart Intensive care Admissions; RITA 3, Randomized Intervention Trial of unstable Angina; TACTICS TIMI-18, Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy

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