Women may have a slightly higher risk of death than men in the 30 days following an acute coronary syndrome (ACS; such as heart attack or unstable angina), but this difference appears attributable to factors such as severity and type of ACS, clinical differences and angiographic severity according to a study in the August 26 issue of JAMA.
"Cardiovascular disease is the leading cause of death in both men and women, accounting for one-third of all deaths. Although several studies have shown an improvement of prognosis in women over time, overall outcomes remain worse for women compared with men, providing a strong rationale for focusing on the study of sex-based differences in the outcome of acute coronary syndromes," according to background information in the article. Previous analyses of the differences in outcomes for men and women following ACS have reported conflicting results.
Jeffrey S. Berger, M.D., M.S., of the New York University School of Medicine, New York, and colleagues evaluated the relationship between sex and 30-day mortality following ACS and analyzed factors such as clinical classification at the time of ACS and the severity of angiographic disease. Patients for the study were pooled from a sample of 11 independent, international, randomized ACS clinical trials between 1993 and 2006.
Of the 136,247 patients in this analysis, 38,048 (28 percent) were women. There were 102,004 patients (26 percent women) with ST-segment elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack); 14,466 with non-STEMI (NSTEMI; 29 percent women); and 19,777 with unstable angina (40 percent women). Women were older and had a higher prevalence of hypertension, hyperlipidemia, diabetes and heart failure. Men were more likely to be smokers and had a higher prevalence of prior heart attack and prior coronary artery bypass graft surgery.
The researchers found that women had a significantly higher unadjusted 30-day risk of death compared with men (9.6 percent vs. 5.3 percent). But after multivariable adjustment for clinical characteristics and clinical presentation, no significant difference was observed in 30-day mortality.