Women with Acute Coronary Syndromes are less Invasively Treated than Men in the Acute Phase in an Argentine Population

pp. 296-301

Abstract

Introduction

Bibliographic reports indicate that women with coronary disease have worse prognosis than men and are submitted to less diagnostic methods and interventions. It is, therefore, of interest to establish whether this tendency exists in our country and its potential prognostic associations.

Objectives

The aim of the study was to analyze in an Argentine cohort of acute coronary syndrome, the clinical characteristics, treatment and outcome at two-year follow up.

Methods

The Argentine component of the GRACE cooperative study included 4708 men and 2027 women with acute coronary syndrome without persistent ST-segment elevation. Previous history, type of presentation, final diagnosis, pharmacological treatments, revascularization and cumulative incidence of death and recurrent infarction were analyzed during hospitalization and at 6-month and 2-year follow-up.

Results

Women were older than men (69.4 ± 12.3 vs. 63.1 ± 11.9 years, p <0.01), and had greater prevalence of heart failure and hypertension. The proportions of ischemic electrocardiographic changes and abnormal cardiac enzymes were similar in both sexes. Use of aspirin, clopidogrel and beta blockers was significantly lower in women, who had 50% chance of undergoing either percutaneous coronary intervention (OR= 0.55;95% CI 0.48-0.62) or coronary artery bypass graft surgery (OR= 0.49; 95% CI 0.36-0.67) than men. The crude incidences of mortality and reinfarction during hospitalization and at two-year follow up were higher in women with no differences in the relative risk of major events after adjusting for age and other covariates.

Conclusions

Despite similar risk than men to that of men, women were exposed to fewer interventions during hospitalization. Our results should alert physicians to indicate antiischemic treatments and interventions adjusted to risk in women.