Gender Affects Mortality After Acute Coronary Syndromes

Differences depend on clinical presentation and angiographic disease severity

TUESDAY, Aug. 25 (HealthDay News) -- Women have different short-term death rates than men following acute coronary syndromes (ACS) depending on clinical presentation, although this appears to be largely due to differences in angiographic disease severity, according to a study in the Aug. 26 issue of the Journal of the American Medical Association.

Jeffrey S. Berger, M.D., from the New York University School of Medicine in New York City, and colleagues compared 30-day mortality following ACS among 136,247 patients (28 percent women) who had participated in various randomized clinical trials for ACS. Of these, 102,004 had ST-segment elevation myocardial infarction (STEMI, 26 percent women), 14,466 had non-STEMI (29 percent women), and 19,777 had unstable angina (40 percent women).

After adjusting for various factors, the researchers found that mortality was similar overall among women and men (adjusted odds ratio, 1.06). However, mortality was higher for women with STEMI (adjusted odds ratio, 1.15), lower for women with non-STEMI (adjusted odds ratio, 0.77), and lower in women with unstable angina (adjusted odds ratio, 0.55). These gender differences based on ACS type disappeared after further adjusting for angiographic disease severity.

"Sex-based differences existed in 30-day mortality among patients with ACS and vary depending on clinical presentation," Berger and colleagues conclude. "However, these differences appear to be largely explained by clinical differences at presentation and severity of angiographically documented disease."

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