Women and men diagnosed with acute coronary syndrome – sex-related differences

Magdalena Dudek; Marta Kałużna-Oleksy; Jacek Migaj; Ewa Straburzyńska-Migaj

doi:10.20883/jms.2018.268

Authors

Magdalena Dudek Ist Cardiology Department, Poznan University of Medical Sciences
Marta Kałużna-Oleksy Ist Cardiology Department, Poznan University of Medical Sciences
Jacek Migaj Ist Cardiology Department, Poznan University of Medical Sciences
Ewa Straburzyńska-Migaj Ist Cardiology Department, Poznan University of Medical Sciences

DOI:

https://doi.org/10.20883/jms.2018.268

Keywords:

acute myocardial infarction, coronary artery disease, in-hospital mortality

Abstract

Background. Coronary artery disease (CAD) is one of the most important causes of death in both men and women. There are many gender differences among patients with CAD, including risk factors and acute coronary syndrome (ACS) outcomes. The latest reports showed that mortality due to CAD is higher in women than in men. Cardiac biomarkers play an important role in risk stratification and choice of treatment strategy in patients with ACS, however some of cardiac biomarkers show worse sensitivity and specificity in women.
Aim. The aim was to investigate the sex-related differences in patients with acute coronary syndrome and to compare their sex-related risk of in-hospital mortality.
Material and Methods. Single-center study of patients diagnosed with ACS who underwent precutaneous coronary intervention (PCI). Patients were diagnosed and treated according to ESC Guidelines. Statistical analysis was performed using StatSoft Statistica.
Results. Of the 297 patients included in this study, 32% were women and 68% were men. There were 26.94% STEMI patients, 22.22% NSTEMI patients and 50.84% unstable angina patients. Compared with males, females were significant older (68.2 ± 10.6 vs. 64.8 ± 11.0; p = 0.0175). Levels of biomarkers of myocardial injury were significantly lower in women: CK-MB (p = 0.0241), troponin I (p = 0.0417) and CK (p = 0.0035) than in men. Women were less frequently treated with PCI or CABG (p = 0.0016) but the in-hospital outcomes (cardiogenic shock, sudden cardiac arrest or cardiac death) were similar in both groups (p = 0.8557).
Conclusions. Women with ACS were older and have higher incidence of non-ST-elevation ACS than men.. In-hospital mortality show no significant difference between genders. Women were less likely to receive invasive treatment.

Downloads

Download data is not yet available.

References

Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28-e292. DOI: 10.1161/CIR.0000000000000350.

Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(23):2999–3054. DOI: 10.1093/eurheartj/ehr236.

Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2017 Aug 26. DOI: 10.1093/eurheartj/ehx393.

Hochman JS, McCabe CH, Stone PH, et al. Outcome and profile of women and men presenting with acute coronary syndromes: a report from TIMI IIIB: TIMI Investigators: Thrombolysis in Myocardial Infarction. J Am Coll Cardiol. 1997;30:141–148.

Vaccarino V, Parsons L, Every NR, et al. Sex-based differences in early mortality after myocardial infarction. National Registry of Myocardial Infarction 2 Participants. N Engl J Med. 1999;341(4):217–225.

Knowlton AA, Lee AR. Estrogen and the cardiovascular system. Pharmacol Ther. 2012 Jul;135(1):54–70. DOI: 10.1016/j.pharmthera.2012.03.007.

Vakili BA, Kaplan RC, Brown DL. Sex-based differences in early mortality of patients undergoing primary angioplasty for first acute myocardial infarction. Circulation. 2001;104(25):3034–3038.

Canto JG, Rogers WJ, Goldberg RJ, et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012;307(8):813–822. DOI: 10.1001/jama.2012.199.

Mosleh W, Abdel-Qadir H, Farkouh M. Biomarkers in the emergency workup of chest pain: Uses, limitations, and future. Cleve Clin J Med. 2013;80(9):589–598. DOI: 10.3949/ccjm.80a.12112.

Slagman A, Searle J, Vollert JO, et al. Sex differences of troponin test performance in chest pain patients. Int J Cardiol. 2015 May 6;187:246–251. DOI: 10.1016/j.ijcard.2015.03.261.

Akhter N, Milford-Beland S, Roe MT, et al. Gender differences among patients with acute coronary syndromes undergoing percutaneous coronary intervention in the American College of Cardiology – National Cardiovascular Data Registry (ACC-NCDR). Am Heart J. 2009;157:141–148. DOI: 10.1016/j.ahj.2008.08.012.

Kragholm K, Halim SA, Yang Q, et al. Sex-Stratified Trends in Enrollment, Patient Characteristics, Treatment, and Outcomes Among Non-ST-Segment Elevation Acute Coronary Syndrome Patients: Insights From Clinical Trials Over 17 Years. Circ Cardiovasc Qual Outcomes 2015;8(4):357–367. DOI: 10.1161/CIRCOUTCOMES.114.001615.

Janion-Sadowska A, Sielski J, Gierlotka M, et al. Gender-related differences in clinical course, therapeutic approach and prognosis in patients with non-ST segment elevation myocardial infarction. Kardiol Pol. 2011;69(8):784–792.

Shah ASV, Griffiths M, Lee KK, et al. High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. BMJ. 2015 Jan 21;350:g7873. DOI: 10.1136/bmj.g7873.

Worrall-Carter L, McEvedy S, Wilson A, et al. Impact of comorbidities and gender on the use of coronary interventions in patients with high-risk non-ST-segment elevation acute coronary syndrome. Catheter Cardiovasc Interv. 2016;87(4):E128-E136. DOI: 10.1002/ccd.26117.

Goldkorn R, Naimushin A, Shlomo N, et al. Comparison of the usefulness of heart rate variability versus exercise stress testing for the detection of myocardial ischemia in patients without known coronary artery disease. Am J Cardiol. 2015;115(11):1518–1522. DOI: 10.1016/j.amjcard.2015.02.054.

Harris PR, Stein PK, Fung GL, et al. Heart rate variability measured early in patients with evolving acute coronary syndrome and 1-year outcomes of rehospitalization and mortality. Vasc Health Risk Manag. 2014:5;10:451–464. DOI: 10.2147/VHRM.S57524.

Rubini Gimenez M, Reiter M, Twerenbold R, et al. Sex-Specific Chest Pain Characteristics in the Early Diagnosis of Acute Myocardial Infarction. JAMA Intern Med. 2014;174(2):241–249. DOI: 10.1001/jamainternmed.2013.12199.

Sharma K, Gulati M. Coronary artery disease in women: a 2013 update. Glob Heart. 2013;8:105–112. DOI: 10.1016/j.gheart.2013.02.001.

Wilson PW, D’Agostino RB, Sullivan L, et al. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med. 2002;162:1867–1872.

Herrmann J, Gersh BJ, Goldfinger JZ, et al. Body mass index and acute and long-term outcomes after acute myocardial infarction (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction Trial). Am J Cardiol. 2014;114(1):9–16. DOI: 10.1016/j.amjcard.2014.03.057.

Migaj J, Prokop E, Straburzyńska-Migaj E, et al. Does the influence of obesity on prognosis differ in men and women? A study of obesity paradox in patients with acute coronary syndrome. Kardiol Pol. 2015;73(9):761–767. DOI: 10.5603/KP.a2015.0087.

Tillmanns H, Waas W, Voss R, et al. Gender differences in the outcome of cardiac interventions. Herz. 2005;30(5):375–389.

Patel MB, Bui LP, Kirkeeide RL, et al. Imaging microvascular dysfunction and mechanisms for female-male differences in CAD. JACC Cardiovasc Imaging. 2016;9(4):465–482. DOI: 10.1016/j.jcmg.2016.02.003.

Omland T, de Lemos JA, Holmen OL, et al. Impact of sex on the prognostic value of high-sensitivity cardiac troponin I in the general population: the HUNT study. Clin Chem. 2015;61(4):646–656. DOI: 10.1373/clinchem.2014.234369.