Gender differences in management and outcome in Non-ST-Elevation Acute Coronary Syndrome

Joakim Alfredsson ^1*, Ulf Stenestrand ¹, Lars Wallentin ² and Eva Swahn ¹

¹ Institution of Medicine and Care, University Hospital, Linkoping, Sweden
² Uppsala Clinical Research Center, Uppsala University, Sweden

^* To whom correspondence should be addressed. E-mail: joakim.alfredsson{at}imv.liu.se.

Accepted 10 October 2006

Abstract

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 y vs. 69 y, P<0.001), and more likely to have a history of hypertension and diabetes mellitus, but less likely to have a history of myocardial infarction or revascularization. After adjustment, there were no major differences in acute pharmacological treatment or prophylactic medication at discharge. Revascularisation was however, even after adjustment, more often performed in men (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.09-1.21). After adjustment, there was no significant difference in in-hospital (OR, 1.03; 95% CI, 0.94-1.13) or 30-days (OR, 1.07; 95% CI, 0.99-1.15) mortality, and at 1 year male gender was associated with higher mortality (OR, 1.12; 95% CI, 1.06-1.19).

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

Keywords: Non ST-elevation acute coronary syndrome, gender, myocardial infarction, sex factors, unstable angina

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