Outcome and profile of women and men presenting with acute coronary syndromes: a report from TIMI IIIB. TIMI Investigators. Thrombolysis in Myocardial Infarction

Department of Medicine, St. Luke's/Roosevelt Hospital Center and Columbia University, New York, New York 10025, USA. jsh4@columbia.edu

OBJECTIVES: Women and men enrolled in the Thrombolysis in Myocardial Infarction (TIMI) IIIB trial of unstable angina and non-Q wave myocardial infarction (MI) were evaluated to determine gender differences in characteristics and outcome. BACKGROUND: Coronary heart disease is the leading cause of death for women and men. However, the characteristics and outcome of women compared with men with unstable angina and non-Q wave MI have not been extensively studied. METHODS: The characteristics, outcomes and proportion of 497 women and 976 men with unstable angina and non-Q wave MI at the time of enrollment were compared. When these proportions were noted to be significantly different, we compared them with the 7,731-patient TIMI IIIB Registry, which represents the non-trial, screened population with these syndromes at these centers. RESULTS: For both coronary syndromes, women were older, were less frequently white, had a higher incidence of diabetes and hypertension and were receiving more cardiac medications. The 42-day rate of death and MI in TIMI IIIB was similar for women and men (7.4% vs. 7.5%). Coronary angiography revealed less severe coronary artery disease for women than for men, with absence of critical obstructions in 25% versus 16% and mean ejection fractions 62 +/- 12% versus 57 +/- 13% for women versus men (p < 0.01). Medical management failed in women as often as in men, and rates of cardiac catheterization and percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery were similar for women and men in the conservative strategy arm as well as in the invasive strategy arm. Women in the TIMI IIIB trial had proportionately more unstable angina than did men. The proportion of unstable angina and non-Q wave MI for women was similar in the trial and Registry. However, proportionately more men in the trial had non-Q wave MI than men in the Registry. CONCLUSIONS: 1) Women with each acute coronary syndrome are older than men and have more comorbidity. 2) The outcome with unstable angina and non-Q wave MI is related to severity of illness and not gender. 3) Mortality associated with revascularization for unstable angina and non-Q wave MI was similar for women and men. 4) The proportion of women and men enrolled with each acute coronary syndrome is different. These rates reflect both the prevalence of disease and selection bias owing to trial eligibility criteria and other identified factors.

This article has been cited by other articles:

				M. O'Donoghue, W. E. Boden, E. Braunwald, C. P. Cannon, T. C. Clayton, R. J. de Winter, K. A. A. Fox, B. Lagerqvist, P. A. McCullough, S. A. Murphy, et al. Early Invasive vs Conservative Treatment Strategies in Women and Men With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-analysis JAMA, July 2, 2008; 300(1): 71 - 80. [Abstract] [Full Text] [PDF]

				P. Kaul PhD, W.-C. Chang PhD, C. M. Westerhout MSc, M. M. Graham MD, and P. W. Armstrong MD Differences in admission rates and outcomes between men and women presenting to emergency departments with coronary syndromes Can. Med. Assoc. J., November 6, 2007; 177(10): 1193 - 1199. [Abstract] [Full Text] [PDF]

				J. Alfredsson, U. Stenestrand, L. Wallentin, and E. Swahn Gender differences in management and outcome in non-ST-elevation acute coronary syndrome Heart, November 1, 2007; 93(11): 1357 - 1362. [Abstract] [Full Text] [PDF]

				J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J. Am. Coll. Cardiol., August 14, 2007; 50(7): e1 - e157. [Full Text] [PDF]

				J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J. Am. Coll. Cardiol., August 14, 2007; 50(7): 652 - 726. [Full Text] [PDF]

				M. Karounos, A. M. Chang, J. L Robey, K. L Sease, F. S Shofer, C. Follansbee, and J. E Hollander TIMI risk score: does it work equally well in both males and females? Emerg. Med. J., July 1, 2007; 24(7): 471 - 474. [Abstract] [Full Text] [PDF]

				G W Mikhail Coronary revascularisation in women Heart, May 1, 2006; 92(suppl_3): iii19 - iii23. [Abstract] [Full Text] [PDF]

				M. Stramba-Badiale, K. M. Fox, S. G. Priori, P. Collins, C. Daly, I. Graham, B. Jonsson, K. Schenck-Gustafsson, and M. Tendera Cardiovascular diseases in women: a statement from the policy conference of the European Society of Cardiology Eur. Heart J., April 2, 2006; 27(8): 994 - 1005. [Abstract] [Full Text] [PDF]

				A. J. Lansky, J. S. Hochman, P. A. Ward, G. S. Mintz, R. Fabunmi, P. B. Berger, G. New, C. L. Grines, C. G. Pietras, M. J. Kern, et al. Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women: A Statement for Healthcare Professionals From the American Heart Association Circulation, February 22, 2005; 111(7): 940 - 953. [Abstract] [Full Text] [PDF]

				R. Bugiardini and C. N. Bairey Merz Angina With "Normal" Coronary Arteries: A Changing Philosophy JAMA, January 26, 2005; 293(4): 477 - 484. [Abstract] [Full Text] [PDF]

				T.C. Clayton, S.J. Pocock, R.A. Henderson, P.A. Poole-Wilson, T.R.D. Shaw, R. Knight, and K.A.A. Fox Do men benefit more than women from an interventional strategy in patients with unstable angina or non-ST-elevation myocardial infarction? The impact of gender in the RITA 3 trial Eur. Heart J., September 2, 2004; 25(18): 1641 - 1650. [Abstract] [Full Text] [PDF]

				C. A. Nienaber, R. Fattori, R. H. Mehta, B. M. Richartz, A. Evangelista, M. Petzsch, J. V. Cooper, J. L. Januzzi, H. Ince, U. Sechtem, et al. Gender-Related Differences in Acute Aortic Dissection Circulation, June 22, 2004; 109(24): 3014 - 3021. [Abstract] [Full Text] [PDF]

				R. Moreno, A. Villate, J. Zamorano, C. Almeria, J.-A. Perez-Gonzalez, J.-L. Rodrigo, L. P. de Isla, L. Mataix, and C. Macaya Identifying patients without favourable long-term outcome among those with medically stabilized unstable angina and a negative dipyridamole stress echocardiogram Eur J Echocardiogr, June 1, 2004; 5(3): 205 - 211. [Abstract] [Full Text] [PDF]

				A. Rosengren, L. Wallentin, A. K. Gitt, S. Behar, A. Battler, and D. Hasdai Sex, age, and clinical presentation of acute coronary syndromes Eur. Heart J., April 2, 2004; 25(8): 663 - 670. [Abstract] [Full Text] [PDF]

				A. Elsaesser and C. W. Hamm Acute Coronary Syndrome: The Risk of Being Female Circulation, February 10, 2004; 109(5): 565 - 567. [Full Text] [PDF]

				S. D. Wiviott, C. P. Cannon, D. A. Morrow, S. A. Murphy, C. M. Gibson, C. H. McCabe, M. S. Sabatine, N. Rifai, R. P. Giugliano, P. M. DiBattiste, et al. Differential Expression of Cardiac Biomarkers by Gender in Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction 18) Substudy Circulation, February 10, 2004; 109(5): 580 - 586. [Abstract] [Full Text] [PDF]

				S. S. Rathore, J. M. Foody, M. J. Radford, and H. M. Krumholz Sex Differences in Use of Coronary Revascularization in Elderly Patients After Acute Myocardial Infarction: A Tale of Two Therapies Chest, December 1, 2003; 124(6): 2079 - 2086. [Abstract] [Full Text] [PDF]

				E. Braunwald Application of Current Guidelines to the Management of Unstable Angina and Non-ST-Elevation Myocardial Infarction Circulation, October 21, 2003; 108(90161): III-28 - 37. [Abstract] [Full Text] [PDF]

				R. Glaser, H. C. Herrmann, S. A. Murphy, L. A. Demopoulos, P. M. DiBattiste, C. P. Cannon, and E. Braunwald Benefit of an Early Invasive Management Strategy in Women With Acute Coronary Syndromes JAMA, December 25, 2002; 288(24): 3124 - 3129. [Abstract] [Full Text] [PDF]

				J. S. Hochman and J. E. Tamis-Holland Acute Coronary Syndromes: Does Sex Matter? JAMA, December 25, 2002; 288(24): 3161 - 3164. [Full Text] [PDF]

				P. P. Brown, M. J. Mack, A. W. Simon, S. Battaglia, L. Tarkington, S. Horner, S. D. Culler, and E. R. Becker Outcomes experience with off-pump coronary artery bypass surgery in women Ann. Thorac. Surg., December 1, 2002; 74(6): 2113 - 2119. [Abstract] [Full Text] [PDF]

				S. S. Rathore, Y. Wang, M. J. Radford, D. L. Ordin, and H. M. Krumholz Sex Differences in Cardiac Catheterization after Acute Myocardial Infarction: The Role of Procedure Appropriateness Ann Intern Med, September 17, 2002; 137(6): 487 - 493. [Abstract] [Full Text] [PDF]

				C. Mueller, F.-J. Neumann, H. Roskamm, P. Buser, J. Mc. B. Hodgson, A. P. Perruchoud, and H. J. Buettner Women do have an improved long-term outcome after non-ST-elevation acute coronary syndromes treated very early and predominantly with percutaneous coronary intervention: A prospective study in 1,450 consecutive patients J. Am. Coll. Cardiol., July 17, 2002; 40(2): 245 - 250. [Abstract] [Full Text] [PDF]

				N. K Wenger Clinical characteristics of coronary heart disease in women: emphasis on gender differences Cardiovasc Res, February 15, 2002; 53(3): 558 - 567. [Full Text] [PDF]

				S. C. Wong, L. A. Sleeper, E. S. Monrad, M. A. Menegus, A. Palazzo, V. Dzavik, A. Jacobs, X. Jiang, J. S. Hochman, and for the SHOCK Investigators Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction: A report from the SHOCK Trial Registry J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1395 - 1401. [Abstract] [Full Text] [PDF]

				B. Lagerqvist, K.a. Safstrom, E. Stahle, L. Wallentin, E. Swahn, and the FRISC II Study Group Investigators Is early invasive treatment of unstable coronary artery disease equally effective for both women and men? J. Am. Coll. Cardiol., July 1, 2001; 38(1): 41 - 48. [Abstract] [Full Text] [PDF]

				T. Rutledge, S. E. Reis, M. Olson, J. Owens, S. F. Kelsey, C. J. Pepine, N. Reichek, W. J. Rogers, C. N. Bairey Merz, G. Sopko, et al. History of anxiety disorders is associated with a decreased likelihood of angiographic coronary artery disease in women with chest pain: the WISE study J. Am. Coll. Cardiol., March 1, 2001; 37(3): 780 - 785. [Abstract] [Full Text] [PDF]

				V. Vaccarino, H. M. Krumholz, J. Yarzebski, J. M. Gore, and R. J. Goldberg Sex Differences in 2-Year Mortality after Hospital Discharge for Myocardial Infarction Ann Intern Med, February 6, 2001; 134(3): 173 - 181. [Abstract] [Full Text] [PDF]

				A Rosengren, C.-L Spetz, M Koster, N Hammar, L Alfredsson, and M Rosen Sex differences in survival after myocardial infarction in Sweden. Data from the Swedish National Acute Myocardial Infarction register Eur. Heart J., February 2, 2001; 22(4): 314 - 322. [Abstract] [PDF]

				E. Braunwald, E. M. Antman, J. W. Beasley, R. M. Califf, M. D. Cheitlin, J. S. Hochman, R. H. Jones, D. Kereiakes, J. Kupersmith, T. N. Levin, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment elevation myocardial infarction: A report of the american college of cardiology/ american heart association task force on practice guidelines (committee on the management of patients with unstable angina) J. Am. Coll. Cardiol., September 1, 2000; 36(3): 970 - 1062. [Full Text] [PDF]

				K.a. Safstrom, B. Lindahl, E. Swahn, and the FRISC-Study Group Risk stratification in unstable coronary artery disease: Exercise test and troponin T from a gender perspective J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1791 - 1800. [Abstract] [Full Text] [PDF]

				P Abrahamsson, A Rosengren, and M Dellborg Improved long-term prognosis for patients with unstable coronary syndromes 1988-1995 Eur. Heart J., April 1, 2000; 21(7): 533 - 539. [Abstract] [PDF]

				D. B. Mark Sex Bias in Cardiovascular Care: Should Women Be Treated More Like Men? JAMA, February 2, 2000; 283(5): 659 - 661. [Full Text] [PDF]

				K Safstrom and E Swahn Early symptom-limited exercise test for risk stratification in post menopausal women with unstable coronary artery disease Eur. Heart J., February 1, 2000; 21(3): 230 - 238. [Abstract] [PDF]

				S. R. Eachempati, L. Hydo, and P. S. Barie Gender-Based Differences in Outcome in Patients With Sepsis Arch Surg, December 1, 1999; 134(12): 1342 - 1347. [Abstract] [Full Text] [PDF]

				K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347. [Full Text] [PDF]

				J. S. Hochman, J. E. Tamis, T. D. Thompson, W. D. Weaver, H. D. White, F. Van de Werf, P. Aylward, E. J. Topol, R. M. Califf, and The Global Use of Strategies to Open Occluded Coro Sex, Clinical Presentation, and Outcome in Patients with Acute Coronary Syndromes N. Engl. J. Med., July 22, 1999; 341(4): 226 - 232. [Abstract] [Full Text] [PDF]

				L. F. Wexler Studies of Acute Coronary Syndromes in Women -- Lessons for Everyone N. Engl. J. Med., July 22, 1999; 341(4): 275 - 276. [Full Text]

				L. Mosca, J. E. Manson, S. E. Sutherland, R. D. Langer, T. Manolio, E. Barrett-Connor, and E. Barrett-Connor Cardiovascular Disease in Women : A Statement for Healthcare Professionals From the American Heart Association Circulation, October 7, 1997; 96(7): 2468 - 2482. [Full Text]

				Women and Acute Coronary Syndromes Journal Watch Women's Health, September 1, 1997; 1997(901): 3 - 3. [Full Text]