Prognostic Differences between Men and Women with Acute Coronary Syndrome. Data from a Brazilian Registry
Alexandre de Matos Soeiro
Pedro Gabriel Melo de Barros e Silva
Eduardo Alberto de Castro Roque
Aline Siqueira Bossa
Tatiana de Carvalho Andreucci Torres Leal
Maria Carolina Feres de Almeida Soeiro
Fábio Grunspun Pitta
Carlos V. Serrano Jr.
Múcio Tavares Oliveira Jr.
Dr. Alexandre de Matos Soeiro
Background: Gender-related differences have been reported in patients with acute coronary syndrome. The description of this comparative finding in a Brazilian registry has not yet been documented.
Objective: To compare male vs. female patients regarding the baseline characteristics, coronary findings, treatment and in-hospital and long-term prognosis.
Methods: This is a retrospective, multicenter and observational study that included 3,745 patients (2,437 males and 1,308 females) between May 2010 and May 2015. The primary in-hospital outcome was all-cause mortality. The secondary outcome consisted of combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed using the chi-square and the t test, considering p < 0.05 as significant. In the long term, mortality and combined events were assessed using the Kaplan-Meier method, with a mean follow-up of 8.79 months.
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 in 72.9% of the women and 67.8% of the men (p = 0.001). Percutaneous coronary intervention was carried out in 44.9% of the males and 35.4% of the females (p < 0.0001), and coronary artery bypass grafting (CABG) was performed in 17% of the males and 11.8% of females (p < 0.0001), with a higher prevalence of three-vessel coronary artery disease in males (27.3% vs. 16.2%, p < 0.0001). Approximately 79.9% of the female patients received a diagnosis of acute coronary syndrome without ST-segment elevation, while in the male patients, this diagnosis was attained in 71.5% (p < 0.0001). No significant differences were observed between the groups in the short and long term, regarding both mortality and the combined events.
Conclusion: Several gender-related differences were observed in patients with acute coronary syndrome regarding the demographic characteristics, coronary artery disease pattern and implemented treatment. However, the prognostic evolution was similar between the groups. (Arq Bras Cardiol. 2018; 111(5):648-653)
Keywords: Acute Coronary Syndrome/epidemiology; Prognosis; Gender Indentify; Multicenter Study; Mortality; Hypertension; Percutaneous Coronary Intervention.