Gender differences in outcomes during initial hospitalization and at 1-year follow-up of patients with acute coronary syndrome: experience from the Croatian branch of the ISACS-CT Registry

    Authors

    Keywords

    acute coronary syndrome, ISACS-CT registry, gender differences, outcomes

    DOI

    https://doi.org/10.15836/ccar2018.438

    Full Text

    Background and Aim : Women with ST-segment elevation myocardial infarction (STEMI) have a higher 30-day risk of all-cause mortality. ( 1 ) The aim is to study gender differences in in-hospital mortality and mortality at 1-year follow-up in the Croatian branch of the ISACS-CT registry (NCT01218776). Patients and Methods : From January 2012 to October 2017, 1898 patients were enrolled; 46% (n=881) presenting with STEMI, 36% (n=685) with non-ST-segment elevation myocardial infarction (NSTEMI), and 18% (n=332) with unstable angina (UA). Follow-up was performed on 33% (n=630) of the cohort, 44% (n=275) with STEMI, 34% (n=217) NSTEMI, and 22% (n=138) with UA. Results : At admission women were older, more burdened with comorbidities, and arrived at the hospital with a longer delay from symptom onset ( Figure 1 ). During hospitalization, there were no gender differences in reaching an ejection fraction (EF) below 40%. Nevertheless, women with STEMI had significantly worse outcomes in the acute period ( Table 1 ) . After adjusting for gender, in-hospital mortality was associated with age (OR 1.09, 95% CI 1.06-1.13, p<0.001) and primary percutaneous coronary intervention (PCI) (OR 0.45, 95% CI 0.24-0.86, p=0.015). At hospital discharge there was no gender difference in prescribed ACE-inhibitors or statins, whereas after 1-year there was a significant reduction in ACE-inhibitor (female vs. male: 68.3% vs. 81.1%, p=0.042) and statin therapy in women ( Figure 2 ). During follow-up, 15.7% of patients reached <40% EF, 7.6% underwent repeated PCI, 2.7% were readmitted with NSTEMI or UA, 1.3% hospitalized for heart failure, 0.8% had a coronary artery bypass graft (CABG) procedure, 0.6% a stroke or a transitory ischemic attack, and 0.5% were readmitted with STEMI. There was no gender difference in all-cause mortality or in any of the endpoints. After adjustment for the type of acute coronary event at initial presentation and gender - age (HR 1.10, 95% CI 1.06-1.15, p<0.001), EF at discharge (HR 0.95, 95% CI 0.92-0.97, p<0.001) and primary PCI (HR 0.30, 95% CI 0.13-0.65, p=0.002) proved to be significant predictors of survival. 
 Conclusion : Our results concur with the current findings of significantly increased in-hospital mortality of female STEMI patients. At 1-year follow-up there was no gender disproportion in mortality or other endpoints. A decrease in statin therapy was noted in women during follow-up, suggesting more through control might be needed to maintain the prescription of statins or compliance. Gender differences in comorbidities and admission time in patients admitted due to acute coronary syndrome. Statin therapy over time in patients with acute coronary syndrome.

    Cardiologia Croatica
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    Gender differences in outcomes during initial hospitalization and at 1-year follow-up of patients with acute coronary syndrome: experience from the Croatian branch of the ISACS-CT Registry

    Extended Abstract
    Issue11-12
    Published
    Pages438-439
    PDF via DOIhttps://doi.org/10.15836/ccar2018.438
    acute coronary syndrome
    ISACS-CT registry
    gender differences
    outcomes

    Authors

    Filip Lončarić*ORCIDInstitute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
    Petra MjehovićORCIDInstitute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
    Dorja SabljakORCIDInstitute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
    Antonija MiškovićORCIDInstitute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
    Dominik OrozORCIDInstitute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
    Ines VinkovićORCIDInstitute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
    Vedrana VlahovićORCIDInstitute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
    Grgur SalaiORCIDInstitute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
    Saša PavasovićORCIDInstitute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
    Nina JakušORCIDInstitute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
    Dora FabijanovićORCIDInstitute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
    Maja ČikešORCIDInstitute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
    Davor MiličićORCIDInstitute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain

    Full Text

    Background and Aim : Women with ST-segment elevation myocardial infarction (STEMI) have a higher 30-day risk of all-cause mortality. ( 1 ) The aim is to study gender differences in in-hospital mortality and mortality at 1-year follow-up in the Croatian branch of the ISACS-CT registry (NCT01218776). Patients and Methods : From January 2012 to October 2017, 1898 patients were enrolled; 46% (n=881) presenting with STEMI, 36% (n=685) with non-ST-segment elevation myocardial infarction (NSTEMI), and 18% (n=332) with unstable angina (UA). Follow-up was performed on 33% (n=630) of the cohort, 44% (n=275) with STEMI, 34% (n=217) NSTEMI, and 22% (n=138) with UA. Results : At admission women were older, more burdened with comorbidities, and arrived at the hospital with a longer delay from symptom onset ( Figure 1 ). During hospitalization, there were no gender differences in reaching an ejection fraction (EF) below 40%. Nevertheless, women with STEMI had significantly worse outcomes in the acute period ( Table 1 ) . After adjusting for gender, in-hospital mortality was associated with age (OR 1.09, 95% CI 1.06-1.13, p<0.001) and primary percutaneous coronary intervention (PCI) (OR 0.45, 95% CI 0.24-0.86, p=0.015). At hospital discharge there was no gender difference in prescribed ACE-inhibitors or statins, whereas after 1-year there was a significant reduction in ACE-inhibitor (female vs. male: 68.3% vs. 81.1%, p=0.042) and statin therapy in women ( Figure 2 ). During follow-up, 15.7% of patients reached <40% EF, 7.6% underwent repeated PCI, 2.7% were readmitted with NSTEMI or UA, 1.3% hospitalized for heart failure, 0.8% had a coronary artery bypass graft (CABG) procedure, 0.6% a stroke or a transitory ischemic attack, and 0.5% were readmitted with STEMI. There was no gender difference in all-cause mortality or in any of the endpoints. After adjustment for the type of acute coronary event at initial presentation and gender - age (HR 1.10, 95% CI 1.06-1.15, p<0.001), EF at discharge (HR 0.95, 95% CI 0.92-0.97, p<0.001) and primary PCI (HR 0.30, 95% CI 0.13-0.65, p=0.002) proved to be significant predictors of survival. 
 Conclusion : Our results concur with the current findings of significantly increased in-hospital mortality of female STEMI patients. At 1-year follow-up there was no gender disproportion in mortality or other endpoints. A decrease in statin therapy was noted in women during follow-up, suggesting more through control might be needed to maintain the prescription of statins or compliance. Gender differences in comorbidities and admission time in patients admitted due to acute coronary syndrome. Statin therapy over time in patients with acute coronary syndrome.