Coronary artery disease
Gender Differences in Acute Non–ST-Segment Elevation Myocardial Infarction

https://doi.org/10.1016/j.amjcard.2006.01.072Get rights and content

To assess gender-based differences in presentation and outcome after non–ST-elevation myocardial infarction (NSTEMI) in clinical practice, this study examined data from the Acute Coronary Syndrome registry, which enrolled 16,817 patients from 2000 through the end of 2002, 6,358 of them with NSTEMIs (34.1% women). Women with NSTEMIs were 7.5 years older, had a history of myocardial infarction and percutaneous coronary intervention or coronary artery bypass graft less often, and were less likely to have smoked. They more often had a history of systemic hypertension and diabetes mellitus, but this difference was due to their older age. Reperfusion therapy was performed less often in women, which still was significant after adjustment for baseline variables (odds ratio 0.71, 95% confidence interval 0.63 to 0.80). Clopidogrel was given less often in women (43.4% vs 56%). After adjustment for age, gender differences in medical therapy with statins, aspirin, and β blockers were not significant. Hospital mortality was 1.7 times greater in women. This difference was not significant after adjustment for age (odds ratio 1.07, 95% confidence interval 0.84 to 1.35). Women had greater crude long-term mortality, but after age adjustment, this difference was no longer significant (odds ratio 0.92, 95% confidence interval 0.76 to 1.11). In conclusion, women with NSTEMIs were older than men and thus more often had concomitant diseases but less often had a history of myocardial infarction or coronary artery bypass grafts. They less often received acute percutaneous coronary intervention and less often were treated with clopidogrel. However, there was no difference in age-adjusted mortality in women.

Section snippets

The ACOS registry

The ACOS registry was a prospective German multicenter registry investigating the current treatment of acute coronary syndromes. The 155 participating hospitals were located in Germany and included university hospitals, community hospitals, and tertiary care centers, all providing intensive care units and medical reperfusion therapy, some with facilities for cardiac catheterization and balloon angioplasty. During the entire study, all patients with acute coronary syndromes were registered

Baseline characteristics

From June 2000 to December 2002, a total of 6,358 consecutive patients with NSTEMIs were admitted to 154 participating hospitals. One third of all patients were women (n = 2,168). Women were 7.5 years older than men. Women less often had a history of myocardial infarction, PCI, coronary artery bypass grafting, and renal failure. They less often were smokers compared with men. Systemic hypertension, diabetes mellitus, and obesity were more often present in women. After age adjustment, there was

Discussion

After correction for age, there was no difference in hospital and long-term mortality for NSTEMI between men and women, although acute PCI was performed less often in women and women less often were treated with glycoprotein IIb/IIIa antagonists and clopidogrel.

In accordance with studies of acute coronary syndromes,3, 4, 5, 6, 7, 8, 9, 10, 11 our study showed that women and men with NSTEMIs were different in their risk profiles: women were older than men by an average of 7.5 years and had a

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This study was supported by a grant from MSD Sharp & Dohme, Haar, Germany.

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