Authors

• Filip Lončarić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-7865-1108
• Dora Fabijanović — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-2633-3439
• Nina Jakuš — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-7304-1127
• Petra Mjehović — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-4908-4674
• Dorja Sabljak — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-7785-5555
• Antonija Mišković — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-8483-3856
• Dominik Oroz — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-9837-7214
• Maja Čikeš — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-4772-5549
• Davor Miličić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-9101-1570

Abstract

**Background**: Women have poorer outcomes in acute coronary syndrome (ACS) due to older age, comorbidities, atypical presentation and delay in admission. (1) The aim is to consider gender differences in outcomes in the Croatian Branch of the ISACS-CT registry. **Methods**: From January 2012 to February 2017, 1808 patients were enrolled in the Croatian branch of the registry, 46% (n=844) presenting with acute ST segment elevation acute myocardial infarction (STEMI), 35% (n=637) with non-ST segment elevation myocardial infarction (NSTEMI) and 18% (n=327) with unstable angina. Sex ratio, male to female, was 2.2:1, the median age 65 (57-75) years. In-hospital mortality was defined as the primary outcome. **Results**: There was no sex difference in type of ACS at admission. Women were significantly older, generally more burdened with comorbidities and arrived to the hospital with more delay from symptom onset (women vs. men: in the first 2 h - 19% vs. 24%, p=0.02; in the first 6 h - 49% vs. 58%, p0.01) (**Figure 2**). There was no gender difference in undergoing percutaneous coronary intervention (PCI), but successful revascularization was less often achieved in women (92% vs. 97%, p<0.01). Moreover, female sex (OR = 4.7, CI 95% 1.5-14.7, p=0.021), together with creatinine levels (OR=1.01) and GB IIB/IIIA administration (OR=2.7), proved independently associated with in-hospital mortality in the PCI group, whereas this effect was not seen in the non-invasive treatment group. FIGURE 1. Sex differences in in-hospital mortality. STEMI = ST segment elevation acute myocardial infarction, NSTEMI = non-ST segment elevation myocardial infarction, PCI = percutaneous coronary intervention Figure 2. Sex differences in in-hospital mortality in patients with acute ST segment elevation myocardial infarction depending on time from onset of symptoms to admission. STEMI = ST segment elevation acute myocardial infarction **Conclusion**: Gender differences in patients presenting with STEMI are visible in the Croatian branch of the ISACS-CT registry. In this setting, female sex bears risk of worse outcome associated with delay in admission and invasive treatment.

Keywords

acute coronary syndrome, ISACS-CT, gender differences, ST segment elevation acute myocardial infarction

DOI

Literature

1. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2017;2017(Aug):26. https://doi.org/10.1093/eurheartj/ehx393