CLINICAL RESEARCH: ACUTE CORONARY SYNDROME
Differences in the Management and Prognosis of Women and Men Who Suffer From Acute Coronary Syndromes
Sonia S. Anand, MD, PhD, FRCPc*,*,
Chang Chun Xie, MSc, PhD*,
Shamir Mehta, MD, MSc, FRCPc*,
Maria Grazia Franzosi, Biol ScD ,
Campbell Joyner, MD, FRCPc ,
Susan Chrolavicius, BSc*,
Keith A.A. Fox, MD, FRCP ,
Salim Yusuf, DPhil, FRCPc* for the CURE Investigators
* Department of Medicine and Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
Department of Cardiovascular Research, Mario Negri Institute, Milan, Italy
Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario, Canada
The Royal Infirmary, Edinburgh, United Kingdom
Manuscript received January 27, 2005;
revised manuscript received May 3, 2005,
accepted May 22, 2005.
* Reprint requests and correspondence: Dr. Sonia S. Anand, McMaster Clinic-5th Floor, Hamilton General Hospital, Hamilton Health Sciences, 237 Barton Street East, Hamilton, Ontario, Canada L8L 2X2. (Email: anands{at}mcmaster.ca).
OBJECTIVES: The purpose of this research was to determine if sex and gender differences in the management of acute coronary syndromes (ACS) are associated with differences in prognosis after ACS.
BACKGROUND: Previous investigators have reported sex/gender differences in the management of patients with ACS, but the impact of these differences on prognosis is unclear.
METHODS: We analyzed data from the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial, which enrolled 4,836 women and 7,726 men with ACS. Patients were classified into risk strata using the Thrombolysis In Myocardial Infarction (TIMI) score.
RESULTS: Women underwent fewer invasive procedures including angiography, angioplasty, and coronary artery bypass graft (CABG) surgery (47.6% vs. 60.5%; p = 0.0001) compared to men. No significant differences in cardiovascular death, myocardial infarction (MI), or stroke were observed (9.8% vs. 10.9%; p = 0.04), although women were more likely than men to develop refractory ischemia and to be rehospitalized for chest pain during follow-up (16.6% vs. 13.9%; p = 0.0001). These differences were particularly evident among TIMI high-risk women. A significant interaction between TIMI risk and gender for the outcome of refractory angina and rehospitalization for angina was present.
CONCLUSIONS: Compared to men, high-risk women with ACS undergo less coronary angiography, angioplasty, and CABG surgery, and while they do not have higher incidence cardiovascular death, recurrent MI, or stroke, they suffer an increased rate of refractory ischemia and rehospitalization. All high-risk women and men with ACS should receive optimal medical management, and be considered for coronary angiography with possible revascularization if their coronary anatomy warrants it.
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Abbreviations and Acronyms
| | ACS = acute coronary syndrome | | CABG = coronary artery bypass graft | | CAD = coronary artery disease | | CURE = Clopidogrel in Unstable Angina to Prevent Recurrent Events | | MI = myocardial infarction | | NSTEMI = non–ST-segment elevation myocardial infarction | | PTCA = percutaneous transluminal coronary angioplasty | | TIMI = Thrombolysis In Myocardial Infarction | | UA = unstable angina |
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