Differences in the management and prognosis of women and men who suffer from acute coronary syndromes

Sonia S. Anand, Chang Chun Xie, Shamir Mehta, Maria Grazia Franzosi, Campbell Joyner, Susan Chrolavicius, Keith A A Fox, Salim Yusuf

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: The purpose of this research was to determine if sex and gender differences in the management of acute coronary syndromes (ACS) are associated with differences in prognosis after ACS. BACKGROUND: Previous investigators have reported sex/gender differences in the management of patients with ACS, but the impact of these differences on prognosis is unclear. METHODS: We analyzed data from the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial, which enrolled 4,836 women and 7,726 men with ACS. Patients were classified into risk strata using the Thrombolysis In Myocardial Infarction (TIMI) score. RESULTS: Women underwent fewer invasive procedures including angiography, angioplasty, and coronary artery bypass graft (CABG) surgery (47.6% vs. 60.5%; p = 0.0001) compared to men. No significant differences in cardiovascular death, myocardial infarction (MI), or stroke were observed (9.8% vs. 10.9%; p = 0.04), although women were more likely than men to develop refractory ischemia and to be rehospitalized for chest pain during follow-up (16.6% vs. 13.9%; p = 0.0001). These differences were particularly evident among TIMI high-risk women. A significant interaction between TIMI risk and gender for the outcome of refractory angina and rehospitalization for angina was present. CONCLUSIONS: Compared to men, high-risk women with ACS undergo less coronary angiography, angioplasty, and CABG surgery, and while they do not have higher incidence cardiovascular death, recurrent MI, or stroke, they suffer an increased rate of refractory ischemia and rehospitalization. All high-risk women and men with ACS should receive optimal medical management, and be considered for coronary angiography with possible revascularization if their coronary anatomy warrants it.

Original languageEnglish
Pages (from-to)1845-1851
Number of pages7
JournalJournal of the American College of Cardiology
Volume46
Issue number10
DOIs
Publication statusPublished - Nov 15 2005

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Acute Coronary Syndrome
Myocardial Infarction
clopidogrel
Coronary Angiography
Angioplasty
Coronary Artery Bypass
Sex Characteristics
Ischemia
Stroke
Transplants
Unstable Angina
Chest Pain
Anatomy
Angiography
Research Personnel
Incidence
Research

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Anand, S. S., Xie, C. C., Mehta, S., Franzosi, M. G., Joyner, C., Chrolavicius, S., ... Yusuf, S. (2005). Differences in the management and prognosis of women and men who suffer from acute coronary syndromes. Journal of the American College of Cardiology, 46(10), 1845-1851. https://doi.org/10.1016/j.jacc.2005.05.091

Differences in the management and prognosis of women and men who suffer from acute coronary syndromes. / Anand, Sonia S.; Xie, Chang Chun; Mehta, Shamir; Franzosi, Maria Grazia; Joyner, Campbell; Chrolavicius, Susan; Fox, Keith A A; Yusuf, Salim.

In: Journal of the American College of Cardiology, Vol. 46, No. 10, 15.11.2005, p. 1845-1851.

Research output: Contribution to journalArticle

Anand, SS, Xie, CC, Mehta, S, Franzosi, MG, Joyner, C, Chrolavicius, S, Fox, KAA & Yusuf, S 2005, 'Differences in the management and prognosis of women and men who suffer from acute coronary syndromes', Journal of the American College of Cardiology, vol. 46, no. 10, pp. 1845-1851. https://doi.org/10.1016/j.jacc.2005.05.091
Anand, Sonia S. ; Xie, Chang Chun ; Mehta, Shamir ; Franzosi, Maria Grazia ; Joyner, Campbell ; Chrolavicius, Susan ; Fox, Keith A A ; Yusuf, Salim. / Differences in the management and prognosis of women and men who suffer from acute coronary syndromes. In: Journal of the American College of Cardiology. 2005 ; Vol. 46, No. 10. pp. 1845-1851.
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abstract = "OBJECTIVES: The purpose of this research was to determine if sex and gender differences in the management of acute coronary syndromes (ACS) are associated with differences in prognosis after ACS. BACKGROUND: Previous investigators have reported sex/gender differences in the management of patients with ACS, but the impact of these differences on prognosis is unclear. METHODS: We analyzed data from the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial, which enrolled 4,836 women and 7,726 men with ACS. Patients were classified into risk strata using the Thrombolysis In Myocardial Infarction (TIMI) score. RESULTS: Women underwent fewer invasive procedures including angiography, angioplasty, and coronary artery bypass graft (CABG) surgery (47.6{\%} vs. 60.5{\%}; p = 0.0001) compared to men. No significant differences in cardiovascular death, myocardial infarction (MI), or stroke were observed (9.8{\%} vs. 10.9{\%}; p = 0.04), although women were more likely than men to develop refractory ischemia and to be rehospitalized for chest pain during follow-up (16.6{\%} vs. 13.9{\%}; p = 0.0001). These differences were particularly evident among TIMI high-risk women. A significant interaction between TIMI risk and gender for the outcome of refractory angina and rehospitalization for angina was present. CONCLUSIONS: Compared to men, high-risk women with ACS undergo less coronary angiography, angioplasty, and CABG surgery, and while they do not have higher incidence cardiovascular death, recurrent MI, or stroke, they suffer an increased rate of refractory ischemia and rehospitalization. All high-risk women and men with ACS should receive optimal medical management, and be considered for coronary angiography with possible revascularization if their coronary anatomy warrants it.",
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AU - Anand, Sonia S.

AU - Xie, Chang Chun

AU - Mehta, Shamir

AU - Franzosi, Maria Grazia

AU - Joyner, Campbell

AU - Chrolavicius, Susan

AU - Fox, Keith A A

AU - Yusuf, Salim

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N2 - OBJECTIVES: The purpose of this research was to determine if sex and gender differences in the management of acute coronary syndromes (ACS) are associated with differences in prognosis after ACS. BACKGROUND: Previous investigators have reported sex/gender differences in the management of patients with ACS, but the impact of these differences on prognosis is unclear. METHODS: We analyzed data from the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial, which enrolled 4,836 women and 7,726 men with ACS. Patients were classified into risk strata using the Thrombolysis In Myocardial Infarction (TIMI) score. RESULTS: Women underwent fewer invasive procedures including angiography, angioplasty, and coronary artery bypass graft (CABG) surgery (47.6% vs. 60.5%; p = 0.0001) compared to men. No significant differences in cardiovascular death, myocardial infarction (MI), or stroke were observed (9.8% vs. 10.9%; p = 0.04), although women were more likely than men to develop refractory ischemia and to be rehospitalized for chest pain during follow-up (16.6% vs. 13.9%; p = 0.0001). These differences were particularly evident among TIMI high-risk women. A significant interaction between TIMI risk and gender for the outcome of refractory angina and rehospitalization for angina was present. CONCLUSIONS: Compared to men, high-risk women with ACS undergo less coronary angiography, angioplasty, and CABG surgery, and while they do not have higher incidence cardiovascular death, recurrent MI, or stroke, they suffer an increased rate of refractory ischemia and rehospitalization. All high-risk women and men with ACS should receive optimal medical management, and be considered for coronary angiography with possible revascularization if their coronary anatomy warrants it.

AB - OBJECTIVES: The purpose of this research was to determine if sex and gender differences in the management of acute coronary syndromes (ACS) are associated with differences in prognosis after ACS. BACKGROUND: Previous investigators have reported sex/gender differences in the management of patients with ACS, but the impact of these differences on prognosis is unclear. METHODS: We analyzed data from the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial, which enrolled 4,836 women and 7,726 men with ACS. Patients were classified into risk strata using the Thrombolysis In Myocardial Infarction (TIMI) score. RESULTS: Women underwent fewer invasive procedures including angiography, angioplasty, and coronary artery bypass graft (CABG) surgery (47.6% vs. 60.5%; p = 0.0001) compared to men. No significant differences in cardiovascular death, myocardial infarction (MI), or stroke were observed (9.8% vs. 10.9%; p = 0.04), although women were more likely than men to develop refractory ischemia and to be rehospitalized for chest pain during follow-up (16.6% vs. 13.9%; p = 0.0001). These differences were particularly evident among TIMI high-risk women. A significant interaction between TIMI risk and gender for the outcome of refractory angina and rehospitalization for angina was present. CONCLUSIONS: Compared to men, high-risk women with ACS undergo less coronary angiography, angioplasty, and CABG surgery, and while they do not have higher incidence cardiovascular death, recurrent MI, or stroke, they suffer an increased rate of refractory ischemia and rehospitalization. All high-risk women and men with ACS should receive optimal medical management, and be considered for coronary angiography with possible revascularization if their coronary anatomy warrants it.

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