ABC | Volume 111, Nº5, November 2018

Original Article Soeiro et al ACS in Men vs. women Arq Bras Cardiol. 2018; 111(5):648-653 included. The patients were divided into two groups: male (n = 2,437) and female gender (n = 1,308). There was no exclusion criterion. All patients were submitted to a coronary angiography within 48 hours of admission. All patients who met the criteria established by the last Brazilian Society of Cardiology (SBC) and American Heart Association (AHA) guidelines were considered to be SCA patients. 3,4 Non-ST elevation ACS (NSTE-ACS) was defined as the presence of chest pain associated with electrocardiographic changes, or rise/fall of troponin at hospitalization, or, in the absence of these, as clinical picture and risk factors compatible with unstable angina (chest pain at rest or at minimal effort, severe or occurring with a crescendo pattern). Major bleeding was defined by types 3 and 5 Bleeding Academic Research Consortium (BARC) 4 score, and minor bleeding by types 1 and 2. Reinfarction was considered when there was chest pain recurrence associated with a new elevation in troponin levels. Ischemic cerebrovascular accident (iCVA) was considered when the patient had a new focal motor neurological deficit confirmed by cranial computed tomography. The heart failure outcome was considered when hospitalization was associated with the disease or symptoms with functional class ≥ 2, according to the New York Heart Association classification. The following data were obtained: age, gender, body mass index, presence of diabetes mellitus, systemic arterial hypertension, smoking, dyslipidemia, family history of early coronary disease, heart failure, previous coronary artery disease (AMI, angioplasty or previous CABG), hemoglobin, creatinine, troponin peak, Killip classification, left ventricular ejection fraction, systolic blood pressure, medications used in the first 24 hours of hospitalization and chosen coronary treatment. All patients were referred to the post-discharge consultation between 14 and 30 days, and to a new consultation in 6 months, undergoing ischemia or catheterization tests, requested according to the medical evaluation of the team in charge. Coronary reintervention was necessary in 7.2% of the male patients and 6.4% of the female patients at the follow-up (p = 0.48). The follow-up was carried out through telephone contact and medical record review. The study was submitted to and approved by the Research Ethics Committee. The Free and Informed Consent form was filled out by all the patients included in the study. Statistical analysis The primary in-hospital outcome was all-cause mortality. The secondary outcome consisted of combined events (cardiogenic shock, reinfarction, death, iCVA and bleeding). A descriptive analysis was performed using means and standard deviations, when using parametric tests, and median and interquartile intervals in non-parametric tests. The comparison between groups was performed using the chi‑square test for categorical variables. The unpaired t-test was used for continuous variables, when the Komolgorov-Smirnov normality test showed a normal distribution, considering p < 0.05 as significant. The Mann-Whitney U test was used when the distribution was non-normal. The multivariate analysis was performed by logistic regression only when there was a significant difference between groups in some assessed outcome, considering p < 0.05 as significant. All baseline characteristics shown in Table 1 that showed a significant difference between the groups were considered as variables in the analysis. The medium-term analysis was performed by Log-rank using Kaplan-Meier curves to assess the difference between the groups, with a mean follow-up of 8.79 months. A total of 274 patients were lost to follow-up. The evaluated outcomes were combined events (reinfarction, death and heart failure). A p value < 0.05 was considered significant. The multivariate adjustment was performed only when there was a significant difference between groups in some evaluated outcome. All calculations were performed using the Statistical Package for Social Science (SPSS), version 10.0. Results The mean age was 60.3 years for males and 64.6 for females (p < 0.0001). The most prevalent risk factor was systemic arterial hypertension, observed in 72.9% of the women and 67.8% of the men (p = 0.001). The baseline characteristics of the study population are shown in table 1. Regarding the treatment, percutaneous coronary intervention was performed in 44.9% of the males and 35.4% of female patients (p < 0.0001). Coronary artery bypass grafting was performed in 17.0% of the men vs. 11.8% of the women (p < 0.0001). Regarding the coronary artery disease pattern and the clinical presentation, significant differences were observed between the male and female groups, with 27.3% vs. 16.2% with a three-vessel pattern (p < 0.0001), 18.9% vs. 19.9% with a two-vessel pattern (p = 0.381), 28.5% vs. 20.1% of STE-ACS (p = 0.01) and 71.5% vs. 79.9% of non-ST elevation ACS (NSTE-ACS), respectively (p < 0.0001). Regarding the comparison of in-hospital outcomes, there were no significant differences between the groups regarding mortality (3.1% vs. 3.7%, p = 0.293) and the combined events (12.2% vs. 12, 0%, p = 0.885), respectively, between males and females (Table 2). The medium-term follow-up did not show a significant difference regarding combined events in the male and female groups (31.3% vs. 27.7%, p = 0.769), or in relation to mortality, respectively (Figure 1 and Table 3). Discussion The study showed important data found in the Brazilian population, which are consistent with the results of recent publications in the literature. Significant differences were observed regarding the presence of a greater number of risk factors and older age in the female group. Higher rates of reperfusion (percutaneous or surgical) and ST-elevation ACS in men in comparison to women have also been reported as being significant. Regarding mortality and combined events, there were no significant differences between male and female patients in the short and medium-term. It is estimated that 43 million women have coronary artery disease, which is the leading cause of death in women, with approximately 400,000 deaths per year in the United States. 5 Nearly 43% of ACS patients are women, with approximately 649