Clinical Research
Acute Coronary Syndrome
Differences in the Management and Prognosis of Women and Men Who Suffer From Acute Coronary Syndromes

https://doi.org/10.1016/j.jacc.2005.05.091Get rights and content
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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.

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

Cited by (0)

Funding support for the CURE trial: Sanofi-Synthelabo and Bristol-Myers Squibb. Dr. Anand is a recipient of a Canadian Institutes of Health Research Clinician-Scientist Award and holds the May Cohen Eli Lilly Chair in Women’s Health Research, McMaster University. Dr. Yusuf is a recipient of a Canadian Institutes of Health Research Senior Scientist Award and holds a Heart and Stroke Foundation of Ontario Research Chair.