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Clinical Research Study| Volume 134, ISSUE 9, P1135-1141.e1, September 2021

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Association of Sex with Outcome in Elderly Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Published:May 07, 2021DOI:https://doi.org/10.1016/j.amjmed.2021.03.025
Association of Sex with Outcome in Elderly Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
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      Abstract

      Background

      Worse outcomes have been reported for women, compared with men, after an acute coronary syndrome (ACS). Whether this difference persists in elderly patients undergoing similar invasive treatment has not been studied. We investigated sex-related differences in 1-year outcome of elderly acute coronary syndrome patients treated by percutaneous coronary intervention (PCI).

      Methods

      Patients 75 years and older successfully treated with PCI were selected among those enrolled in 3 Italian multicenter studies. Cox regression analysis was used to assess the independent predictive value of sex on outcome at 12-month follow-up.

      Results

      A total of 2035 patients (44% women) were included. Women were older and most likely to present with ST-elevation myocardial infarction (STEMI), diabetes, hypertension, and renal dysfunction; men were more frequently overweight, with multivessel coronary disease, prior myocardial infarction, and revascularizations. Overall, no sex disparity was found about all-cause (8.3% vs 7%, P = .305) and cardiovascular mortality (5.7% vs 4.1%, P = .113). Higher cardiovascular mortality was observed in women after STEMI (8.8%) vs 5%, P = .041), but not after non ST-elevation-ACS (3.5% vs 3.7%, P = .999). A sensitivity analysis excluding patients with prior coronary events (N = 1324, 48% women) showed a significantly higher cardiovascular death in women (5.4% vs 2.9%, P = .025). After adjustment for baseline clinical variables, female sex did not predict adverse outcome.

      Conclusions

      Elderly men and women with ACS show different clinical presentation and baseline risk profile. After successful PCI, unadjusted 1-year cardiovascular mortality was significantly higher in women with STEMI and in those with a first coronary event. However, female sex did not predict cardiovascular mortality after adjustment for the different baseline variables.

      Keywords

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      Article info

      Publication history

      Published online: May 07, 2021

      Footnotes

      Funding: The Italian Elderly ACS study was promoted by the Italian Society of Interventional Cardiology (SICI-GISE) and the Italian Federation of Cardiology (FIC), and endorsed by the Italian Association of Hospital Cardiologists (ANMCO), and cofinanced by liberal contributions of The Medicines Company, Italy. The Ladies ACS study has been promoted, managed, and coordinated by Istituto di Ricerca e Cura a Carattere Scientifico Arcispedale Santa Maria Nuova in Reggio Emilia, Italy, and cofinanced by liberal contributions and research grants from Novartis Farma, Italy. The Elderly ACS 2 study has been promoted, managed, and coordinated by Istituto di Ricerca e Cura a Carattere Scientifico Arcispedale Santa Maria Nuova in Reggio Emilia, Italy, and cofinanced by liberal contributions and research grants from Eli Lilly and Daiichi Sankyo. Some of the sponsor responsibilities were delegated to the Clinical Research Organization Mediolanum Cardio Research (Milan, Italy). The funders of the studies had no role in study design, data collection, data analysis, or writing of the present report.

      Conflicts of Interest: NM reports grants from Getinge Global and personal fees from Bristol Meyers Squibb. LDL reports personal fees from Amgen, Aspen, Astra Zeneca, Bayer, Boehringer Ingelheim, Chiesi, Eli Lilly, Daiichi Sankyo, Pharmevo, Menarini, The Medicines Company. DG reports personal fees from Pfizer, Sanofi Aventis, and Boehringer Ingelheim. ASP reports personal fees from Medtronic, Boston, and Abbott. LP reports personal fees from Volcano Europe. SDS reports personal fees from Astra Zeneca, Eli Lilly, Bristol Meyer Squibb, Merck Sharp & Dohme, Sonfi, and Pfizer. SS reports grants from Novartis, Eli Lilly, Correvio and personal fees from Astra Zeneca, Bayer, Bristol Meyer Squib, and Pfizer. RDR, GDL, LAF, GT, NF, LM, PS, MC, RA, CC, LL, CL, EM, AR, MF, EC, DC, FP, FP, GG report none.

      Authorship: All authors had access to the data and a role in writing this manuscript.

      Identification

      DOI: https://doi.org/10.1016/j.amjmed.2021.03.025

      Copyright

      © 2021 Elsevier Inc. All rights reserved.

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