Sex-related differences in long-term mortality and heart failure in a contemporary cohort of patients with NSTEACS. The cardiochus-HSUJ registry |
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| Affiliation: | 1. Cardiology Department. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain;2. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV);3. Cardiology Department. Hospital Universitario de San Juan. Alicante, Spain;4. Methodology and Statistics unit. IDIS SUR. Vigo, Spain;1. Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy;2. Medical Oncology, Università Cattolica del Sacro Cuore, Roma, Italy;3. Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy;1. Division of Internal Medicine and Sport Cardiology. Media Valle del Tevere Hospital, Todi, Umbria, Italy;2. Umbria Covid Hospital, Todi, Umbria, Italy;3. Division of Cardiovascular Medicine - Department of Internal Medicine. The Ohio State University, Columbus, Ohio, USA;1. Department of Cardiology, Shaoxing People''s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), No.568, Zhongxing North Road, Shaoxing, Zhejiang Province 312000 China;2. Zhejiang University School of Medicine, Hangzhou, China;3. Department of Cardiology, The First Affiliated Hospital, Zhejiang University, Hangzhou, China;4. Department of Neurology, Shaoxing People''s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China;1. Versiti Blood Research Institute, Milwaukee, WI, USA;2. Medical College of Wisconsin, Milwaukee, WI, USA;3. Department of Medicine, McMaster University, Hamilton, ON, Canada;1. Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L''Hospitalet de Llobregat, Barcelona, Spain;2. Bellvitge Biomedical Research Institute (IDIBELL), L''Hospitalet de Llobregat, Barcelona, Spain;3. Cardio-Oncology Unit, Cardiology Department, Bellvitge University Hospital-Catalan Institute of Oncology (ICO), L''Hospital de Llobregat, Barcelona, Spain;4. Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain |
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| Abstract: | Introduction and objectivesThere is insufficient data regarding sex-related prognostic differences in patients with a non-ST elevation acute coronary syndrome (NSTEACS). We performed a sex-specific analysis of cardiovascular outcomes after NSTEACS using a large contemporary cohort of patients from two tertiary hospitals.MethodsThis work is a retrospective analysis from a prospective registry, that included 5,686 consecutive NSTEACS patients from two Spanish University hospitals between the years 2005 and 2017. We performed a propensity score matching to obtain a well-balanced subset of individuals with the same clinical characteristics, resulting in 3,120 patients. Cox regression models performed survival analyses once the proportional risk test was verified.ResultsAmong the study participants, 1,572 patients (27.6%) were women. The mean follow-up was 60.0 months (standard deviation of 32 months). Women had a higher risk of cardiovascular mortality compared with men (OR (Odds ratio) 1.27, CI (confidence interval) 95% 1.08-1.49), heart failure (HF) hospitalization (OR 1.39, CI 95% 1.18-1.63) and risk of all-cause mortality (OR 1.10, CI 95% 1.08-1.49). After a propensity score matching, female gender was associated with a significant reduction in the risk of total mortality (OR 0.77, CI 95% 0.65-0.90) with a similar risk of cardiovascular mortality (OR 0.86, CI 0.71-1.03) and HF hospitalization (OR 0.92, CI 95% 0.68-1.23). After baseline adjustment, the risk of all-cause mortality and cardiovascular mortality was lower in women, whereas the risk of HF remained similar among sexes.ConclusionsIn a contemporary cohort of patients with NSTEACS, women are at similar risk of developing early and late HF admissions, and have better survival compared with men, with a lower risk of all-cause mortality and cardiovascular mortality. The implementation of NSTEACS guideline recommendations in women, including early revascularization, seems to be accompanied by improved early and long-term prognosis. |
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