Women fare worse than men following revascularization for ACS
medwireNews: Gender-based differences in outcome following cardiac catheterization for acute coronary syndromes (ACS) persist even among those who undergo revascularization, results of a Canadian study suggest.
The researchers analyzed data from 23,473 patients who received cardiac catheterization during their first hospitalization for ACS in Ontario between 2008 and 2011, and found that a significantly lower proportion of women underwent revascularization during the same hospitalization compared with men, at 51.8% versus 66.1%.
The majority of patients undergoing revascularization were treated with percutaneous coronary intervention (83%), and the mean age of patients was 67.3 years for women and 61.7 years for men.
Among patients undergoing coronary revascularization, women had a 1.24-fold increased risk for death or recurrent ACS at 1 year compared with men after accounting for the propensity to undergo revascularization based on factors including age, cardiovascular disease risk, comorbidities, and smoking, with rates of 13.1% versus 10.6%.
And after 2 years of follow-up, there was a 1.20-fold increased risk for this outcome among women (17.4 vs 14.8%), suggesting that “it is unclear whether greater use of early coronary revascularization alone may mitigate sex-based risk differences in outcomes following ACS,” say Jacob Udell (Women’s College Hospital, Toronto) and colleagues.
The authors note that it is not known why these differences occur. They hypothesize that the increased risk for adverse outcomes among women undergoing revascularization “may be in part related to differences in selection of treatment strategies and/or response to invasive treatment in women compared with men,” and note that there were higher rates of bleeding or blood transfusion among women than men (12.8 vs 7.3%).
The team recommends that future studies should address “whether inherent differences in underlying comorbidities or response to invasive therapy and its associated treatment impact outcomes” in order to “develop strategies to reduce the higher rates of adverse outcomes in women.”
By contrast, Udell and colleagues did not observe gender-based differences in clinical outcomes among patients who did not undergo coronary revascularization. Rates of death or recurrent ACS were “overall higher, but relatively similar,” among women and men undergoing medical management, at 17.8% versus 16.9% at 1 year, and 23.0% versus 21.9% at 2 years, they report in the Journal of the American Heart Association.
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