Sex, clinical presentation, and outcome in patients with acute coronary syndromes

Background Studies have reported that women with acute myocardial infarctio n have in-hospital and long-term outcomes that are worse than those of men. Methods To assess sex-based differences in presentation and outcome, we exa mined data from the Global Use of Strategies to Open Occluded Coronary Arte ries in Acute Coronary Syndromes IIb study, which enrolled 12,142 patients (3662 women and 8480 men) with acute coronary syndromes, including infarcti on with ST-segment elevation, infarction with no ST-segment elevation, and unstable angina. Results Overall, the women were older than the men and had significantly hi gher rates of diabetes, hypertension, and prior congestive heart failure. T hey had significantly lower rates of prior myocardial infarction and were l ess likely ever to have smoked. A smaller percentage of women than men had infarction with ST elevation (27.2 percent vs. 37.0 percent, P<0.001), and of the patients who presented with no ST elevation (those with myocardial i nfarction or unstable angina), fewer women than men had myocardial infarcti on (36.6 percent vs. 47.6 percent, P<0.001). Women had more complications t han men during hospitalization and a higher mortality rate at 30 days (6.0 percent vs. 4.0 percent, P<0.001) but had similar rates of reinfarction at 30 days after presentation. However, there was a significant interaction be tween sex and the type of coronary syndrome at presentation (P=0.001). Afte r stratification according to coronary syndrome and adjustment for base-lin e variables, there was a nonsignificant trend toward an increased risk of d eath or reinfarction among women as compared with men only in the group wit h infarction and ST elevation (odds ratio, 1.27; 95 percent confidence inte rval, 0.98 to 1.63; P=0.07). Among patients with unstable angina, female se x was associated with an independent protective effect (odds ratio for infa rction or death, 0.65; 95 percent confidence interval, 0.49 to 0.87; P=0.00 3). Conclusions Women and men with acute coronary syndromes had different clini cal profiles, presentation, and outcomes. These differences could not be en tirely accounted for by differences in base-line characteristics and may re flect pathophysiologic and anatomical differences between men and women. (N Engl J Med 1999;341:226-32.) (C) 1999, Massachusetts Medical Society.