Outcomes of Women Compared With Men After Non-ST-Segment Elevation Acute Coronary Syndromes.

Journal Article (Journal Article)

BACKGROUND: It remains disputed whether women are at excess risk of adverse outcomes versus men after non-ST-segment elevation acute coronary syndromes (NSTEACS) or whether differences are explained by discordant risk factors. OBJECTIVES: A sex-specific analysis of cardiovascular outcomes after NSTEACS across trials conducted by the Thrombolysis In Myocardial Infarction (TIMI) Study Group was performed to determine the impact of sex on cardiovascular outcomes in this dataset. METHODS: Ten TIMI trials were identified that enrolled >2,500 patients with NSTEACS within 30 days of hospitalization. Cox proportional hazards models were used to examine the association of sex with major adverse cardiovascular events (MACE) (cardiovascular death, myocardial infarction, or stroke) after adjusting for relevant risk factors in individual trials; point estimates were then combined by using random effects models. Individual components of the composite outcome and all-cause mortality were also analyzed. RESULTS: Among 68,730 patients with NSTEACS, 19,827 (29%) were women. Women were older and more frequently had hypertension, diabetes, prior heart failure, and renal impairment than men. Before considering relevant confounders, women were at similar risk of MACE compared with men (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 0.99 to 1.09; p = 0.16) but at higher risk of all-cause death (HR: 1.12; 95% CI: 1.01 to 1.24; p = 0.03). After adjustment for baseline differences, risks of MACE (HR: 0.93; 95% CI: 0.88 to 0.98; p < 0.01) and all-cause death (HR: 0.84; 95% CI: 0.78 to 0.90; p < 0.0001) were lower among women compared with men. CONCLUSIONS: After accounting for cardiovascular risk factors, women enrolled in clinical trials were at lower risk of MACE than men after NSTEACS. Women, however, remain undertreated with many evidence-based therapies.

Full Text

Duke Authors

Cited Authors

  • Sarma, AA; Braunwald, E; Cannon, CP; Guo, J; Im, K; Antman, EM; Gibson, CM; Newby, LK; Giugliano, RP; Morrow, DA; Wiviott, SD; Sabatine, MS; O'Donoghue, ML

Published Date

  • December 17, 2019

Published In

Volume / Issue

  • 74 / 24

Start / End Page

  • 3013 - 3022

PubMed ID

  • 31865968

Pubmed Central ID

  • 31865968

Electronic International Standard Serial Number (EISSN)

  • 1558-3597

Digital Object Identifier (DOI)

  • 10.1016/j.jacc.2019.09.065


  • eng

Conference Location

  • United States