ABC | Volume 111, Nº5, November 2018

Original Article Soeiro et al ACS in Men vs. women Arq Bras Cardiol. 2018; 111(5):648-653 Figure 1 – Event-free survival and percentage of combined events in the medium-term comparison between males and females. 1.0 0.8 0.6 0.4 0.2 0.0 Survival x 10 2 (%) 1.0 0.8 0.6 0.4 0.2 0.0 Event-free survival x 10 2 (%) 92.7% 95.4% Mortality Combined events 0 10 20 30 40 0 10 20 30 Time of evolution (months) Time of evolution (months) Female Male 72.3% 68.7% p = 0.769 p = 0.134 A B Table 2 – Univariate analysis comparing different in-hospital outcomes between male vs. female patients Outcomes Male (n = 2,437) n (%) Female (n = 1,308) n (%) p-value Reinfarction 24 (1.0) 14 (1.1) 0.519 Cardiogenic shock 107 (4.4) 41 (3.1) 0.066 Bleeding 73 (3.0) 47 (3.6) 0.655 iCVA 17 (0.7) 7 (0.5) 0.678 Mortality 76 (3.1) 48 (3.7) 0.293 Combined events 297 (12.2) 157 (12.0) 0.885 iCVA: ischemic cerebrovascular accident. Table 3 – Comparison of different medium-term outcomes between the groups of male vs. female patients Outcomes Male (n = 2,256) n (%) Female (n = 1,215) n (%) p-value Reinfarction 183 (8.1) 77 (6.3) 0.980 Heart Failure 359 (15.9) 204 (16.8) 0.783 Mortality 165 (7.3) 56 (4.6) 0.134 Combined events 706 (31.3) 337 (27.7) 0.769 cohort published in 2015, Worrall-Carter et al., 8 assessed 28,985 patients with ACS, showing that the diagnosis of NSTE-ACS was more prevalent among women than men (86% vs. 80%; p < 0.001). 8 In another study, with 7,304 patients, the higher prevalence of NSTE-ACS in women was repeated, accounting for 70.7% of the presentations in the female gender (p < 0.01). 9 As observed in our study, the findings in the Brazilian population follow the same global trends regarding the clinical/ electrocardiographic presentation of ACS between the genders. The coronary anatomy in female patients tends to be less complex, with a lower prevalence of three-vessel disease described in female patients, similarly to our results. The description of the three-vessel coronary artery pattern varies from 15.4% to 36.8% in females, and from 20.5% to 40.8% in males, always with a significant difference in the different analyses. 9,13,14 However, despite the theoretic simpler anatomy regarding the percutaneous coronary reperfusion approach, women are less frequently referred for appropriate treatment in comparison to men. 651