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25-08-2009 | Cardiology | Article

Gender differences in ACS mortality due to clinical, angiographic factors


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MedWire News: Men and women with acute coronary syndrome (ACS) show differences in 30-day mortality, a study has shown, with women more likely to die from ST-segment elevation myocardial infarction (STEMI) and men more likely to die from unstable angina and non-STEMI.

However, these differences were almost completely attenuated after adjusting for the baseline clinical characteristics and angiographic disease severity of the patients.

“Our findings indicate that careful attention to clinical syndrome, clinical characteristics, and coronary anatomy are essential to ascertaining and understanding sex-related differences,” Jeffrey Berger (New York University School of Medicine, USA) and colleagues comment in the Journal of the American Medical Association.

Previous studies of gender-based differences in mortality following ACS have reported conflicting findings. However, these have not fully explored the effect of angiographic severity across the spectrum of ACS, Berger et al note.

“Our study evaluated the relationships among sex, presenting clinical classification, angiographic disease burden, and 30-day mortality following ACS using a large, pooled clinical trials database spanning the full spectrum of ACS,” the researchers comment.

Examining a total of 136,247 patients presenting with ACS (28% female) they found that women had a significantly higher unadjusted 30-day mortality than men (odds ratio [OR]=1.91).

However this effect completely diminished when taking into account baseline clinical characteristics such as the older age of women, and their higher prevalence of hypertension, hyperlipidemia, diabetes, and heart failure.

Nevertheless, there were significant differences in mortality across the ACS spectrum even after adjustment for baseline clinical characteristics. In STEMI, 30-day mortality was higher among women (OR=1.15), whereas in non-STEMI and unstable angina, mortality was lower among women (OR=0.77 and OR=0.55, respectively).

In a cohort of 35,128 patients with angiographic data, women more often had nonobstructive coronary disease than men (15% vs 8%) and less often had two-vessel (25% vs 28%) and three-vessel (23% vs 26%) coronary disease.

Crucially, after additional adjustment for angiographic disease severity, 30-day mortality among women was not significantly different from that in men, regardless of ACS type.

Berger et al speculate: “It is possible that intrinsic differences in angiogenesis and collateralization between women and men play a role, such that a sudden coronary occlusion puts women at greater risk in the setting of STEMI creating more transmural infarctions associated with higher complications.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

By Andrew Czyzewski

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