Sex differences in discharge therapy in young patients with acute coronary syndrome

    Authors

    Keywords

    acute coronary syndrome, myocardial infarction, young, therapy

    DOI

    https://doi.org/10.15836/ccar2021.80

    Full Text

    Introduction: Acute coronary syndrome (ACS), including ST-segment elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UA), has been less researched in the subpopulation of young patients. Sex differences in discharge therapy after ACS have been described in older patients as favouring the male sex ( 1 ), and we decided to test this hypothesis in young patients. The term “young” (with regard to ACS) is not uniquely defined, but according to multiple sources, the proposed cut-off age is 45 years ( 2 ). Patients and Methods: A total of 361 young patients (with an age cut-off of 45 years for men and 55 years for women) with ACS and percutaneous coronary intervention (PCI) performed at the University Hospital Centre Zagreb (UHCZG) between Jan 1 st 2012 and Jan 1 st 2020 were enrolled. The patients were divided into the UHCZG group (241 patients discharged home after ACS) and the PCI network group (120 patients transferred to another medical facility after ACS). We explored statistically relevant associations between sex and discharge therapy using the Pearson chi-square test in the UHCZG group, due to the completeness of this dataset. Results: The mean patient age in the UHCZG group was 44±7 years, and 148 (61.4%) were men. 139 (57.9%) patients had STEMI, 72 (30.0%) NSTEMI, and 29 (12.1%) had UA ( Table 1 , Figure 1 ). Female patients had a higher prevalence of hypothyroidism, lower diastolic blood pressure at admission and higher LDL values ( Table 1 ). A significantly higher proportion of male patients were prescribed with angiotensin-converting enzyme inhibitors (ACEi) (82.4% versus 65.6%, p=0.003). There were no sex differences in the prescription of other cardiovascular drugs ( Table 2 ). Pie chart showing the distribution of types of acute coronary syndrome in the University Hospital Centre Zagreb group. STEMI – ST-segment elevation myocardial infarction;
NSTEMI – non-ST-elevation myocardial infarction. Conclusion: In a group of young patients with ACS, we found a statistically significant difference between male and female patients regarding the prescription of ACEi, despite a lack of significant difference in systolic blood pressure. Results similar to ours, regarding sex differences in optimal medical therapy, have been described in the literature, including young ACS patients ( 3 ).These results raise concerns regarding potentially negative consequences on the health of young women treated for ACS.

    Cardiologia Croatica
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    Sex differences in discharge therapy in young patients with acute coronary syndrome

    Extended Abstract
    Issue1-2
    Published
    Pages80-82
    PDF via DOIhttps://doi.org/10.15836/ccar2021.80
    acute coronary syndrome
    myocardial infarction
    young
    therapy

    Authors

    Filip Puškarić*ORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Nikolina MaglićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Zvonimir OstojićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Ivo PlanincORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Joško BulumORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Davor MiličićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Maja ČikešORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia

    Full Text

    Introduction: Acute coronary syndrome (ACS), including ST-segment elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UA), has been less researched in the subpopulation of young patients. Sex differences in discharge therapy after ACS have been described in older patients as favouring the male sex ( 1 ), and we decided to test this hypothesis in young patients. The term “young” (with regard to ACS) is not uniquely defined, but according to multiple sources, the proposed cut-off age is 45 years ( 2 ). Patients and Methods: A total of 361 young patients (with an age cut-off of 45 years for men and 55 years for women) with ACS and percutaneous coronary intervention (PCI) performed at the University Hospital Centre Zagreb (UHCZG) between Jan 1 st 2012 and Jan 1 st 2020 were enrolled. The patients were divided into the UHCZG group (241 patients discharged home after ACS) and the PCI network group (120 patients transferred to another medical facility after ACS). We explored statistically relevant associations between sex and discharge therapy using the Pearson chi-square test in the UHCZG group, due to the completeness of this dataset. Results: The mean patient age in the UHCZG group was 44±7 years, and 148 (61.4%) were men. 139 (57.9%) patients had STEMI, 72 (30.0%) NSTEMI, and 29 (12.1%) had UA ( Table 1 , Figure 1 ). Female patients had a higher prevalence of hypothyroidism, lower diastolic blood pressure at admission and higher LDL values ( Table 1 ). A significantly higher proportion of male patients were prescribed with angiotensin-converting enzyme inhibitors (ACEi) (82.4% versus 65.6%, p=0.003). There were no sex differences in the prescription of other cardiovascular drugs ( Table 2 ). Pie chart showing the distribution of types of acute coronary syndrome in the University Hospital Centre Zagreb group. STEMI – ST-segment elevation myocardial infarction;
NSTEMI – non-ST-elevation myocardial infarction. Conclusion: In a group of young patients with ACS, we found a statistically significant difference between male and female patients regarding the prescription of ACEi, despite a lack of significant difference in systolic blood pressure. Results similar to ours, regarding sex differences in optimal medical therapy, have been described in the literature, including young ACS patients ( 3 ).These results raise concerns regarding potentially negative consequences on the health of young women treated for ACS.