Author + information
- Barbara E. Staehli,
- Manfred B. Wischnewsky,
- Philipp Jakob,
- Roland Klingenberg,
- Slayman Obeid,
- Dik Heg,
- Lorenz Räber,
- Stephan Windecker,
- Francois Mach,
- Baris Gencer,
- David Nanchen,
- Peter Jüni,
- Ulf Landmesser,
- Christian Matter,
- Thomas F. Lüscher and
- Willibald Maier
Background: Though representing a steeply and steadily increasing percentage of the population in Western industrialized countries, elderly patients are often underrepresented in clinical trials, and earlier studies suggested a gender gap in the management of elderly women with acute coronary syndromes (ACS).
Methods: We investigated gender-related differences in outcomes in elderly (> 75 years) ACS patients referred for coronary angiography and enrolled in the Swiss ACS Cohort between December 2009 and October 2012. Adjudicated major adverse cardiovascular and cerebrovascular events (MACCE) included all-cause mortality, non-fatal myocardial infarction, clinically indicated repeat coronary revascularization, definite stent thrombosis, and transient ischemic attack/stroke defined as primary endpoint.
Results: Among 2'168 patients recruited, 481 (22.2%) patients were >75 years of age (37.4% women and 62.6% men). In patients >75 years, 50.5% and 44.2% of women and men presented with ST-segment elevation myocardial infarction, 45.6% and 52.5% with non-ST-segment elevation myocardial infarction, and 3.9% and 3.3% with unstable angina (p=0.34). Percutaneous coronary intervention was performed in 88.3% and 85.7% of women and men >75 years (p=0.41). In patients >75 years, rates of MACCE at 1 year were 15.0% and 22.9% in women and men (OR 0.59, 95% CI 0.36-0.97, p=0.04), and differences remained significant after adjusting for baseline variables (adjusted OR 0.48, 95% CI 0.26-0.90, p=0.02). Women >75 years had a lower cardiovascular mortality as compared with men (5.6% and 12.3%, OR 0.42, 95% CI 0.20-0.87, p=0.02). In patients ≤75 years, rates of MACCE at 1 year did not differ between gender (9.5% and 8.0% for women and men, adjusted OR 1.28, 95% CI 0.77-2.14, p=0.34). Rates of TIMI major bleeding for women and men were 3.9% and 4.0% in patients >75 years (p=0.96), and 4.6% and 2.8% in those ≤75 years (p=0.11), respectively.
Conclusions: In elderly ACS patients referred for coronary angiography, women had better outcomes with lower rates of MACCE, but a similar risk of bleeding, suggesting that in modern tertiary centers the gender gap in the management of ACS has disappeared in todays cardiac care.
Poster Contributions Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Timely Topics in Acute Coronary Syndromes
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology Presentation Number: 1242-154
- 2017 American College of Cardiology Foundation