OUTCOME AND PROFILE OF WOMEN AND MEN PRESENTING WITH ACUTE CORONARY SYNDROMES - A REPORT FROM TIMI IIIB

Objectives. Women and men enrolled in the Thrombolysis in Myocardial I nfarction (TIMI) IIIB trial of unstable angina and non-Q wave myocardi al infarction (MI) were evaluated to determine gender differences in c haracteristics and outcome. Background. Coronary heart disease is the leading cause of death far 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 characteristi cs, outcomes and proportion of 497 women and 976 men with unstable ang ina and non-Q wave MI at the time of enrollment were compared. When th ese proportions were noted to be significantly different, me compared them with the 7,731-patient TIMI IIIB Registry, which represents the n on-trial, screened population with these syndromes at these centers. R esults. For both coronary syndromes, women were older, were less frequ ently white, had a higher incidence of diabetes and hypertension and w ere receiving more cardiac medications. The 42-day rate of death and M I in TIMI IIIB was similar for women and men (7.4% vs. 7.5%). Coronary angiography revealed less severe coronary artery disease for women th an for men, with absence of critical obstructions in 25% versus 16% an d mean ejection fractions 62 +/- 12% versus 57 +/- 13% for women versu s men (p < 0.01). Medical management failed in women as often as in me n, and rates of cardiac catheterization and percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery mere simi lar for women and men in the conservative strategy arm as well as in t he invasive strategy arm. Women in the TIMI IIIB trial had proportiona tely more unstable angina than did men. The proportion af unstable ang ina 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 s yndrome are older than men and have more comorbidity. 2) The outcome w ith unstable angina and non-Q wave MI is related to severity of illnes s and not gender. 3) Mortality associated with revascularization for u nstable angina and non-Q wave MI was similar for women and men. 4) The proportion of women and men enrolled with each acute coronary syndrom e is different. These rates reflect both the prevalence of disease and selection bias owing to trial eligibility criteria and other identifi ed factors. (C) 1997 by the American College of Cardiology.