Abstract
Background
Over past decades, the incidence of acute coronary syndrome (ACS) has increased in
young women, and greater mortality rates after discharge were observed among young
women vs men. We revisited this issue with contemporary data from the Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome (GENESIS-PRAXY), a multicentre prospective cohort study.
Methods
One thousand two hundred thirteen patients were enrolled in GENESIS-PRAXY from 26
centres across Canada, the United States, and Switzerland between January 2009 and
April 2013. We assessed major adverse cardiac events (MACE) and mortality over 12
months after ACS. The role of sex as a predictor of outcomes was determined with Cox
proportional hazard regression analysis.
Results
We included 1163 patients with complete data. The occurrence of MACE was 9% and 8%
in women and men, respectively (P = 0.75), and 1% of women and men died during follow-up. In adjusted models, there
was no sex difference in the risk of MACE or mortality. The proportion of patients
with all-cause rehospitalization was higher in women (13%) compared with men (9%;
P = 0.006), but cardiac rehospitalization rates were similar in both sexes regardless
of ACS type. Among first rehospitalizations, the majority was classified as cardiac
related (69%), with chest pain or angina (28%) and myocardial infarction (19%) reported
as the most common reasons for first rehospitalization.
Conclusions
Women were more likely than men to be rehospitalized for all causes but not for a
cardiac cause. In contrast to earlier studies, men and women had similar mortality
and MACE outcomes at 1 year.
Résumé
Introduction
Au cours des dernières décennies, l’incidence du syndrome coronarien aigu (SCA) a
augmenté chez les jeunes femmes, mais des taux plus élevés de mortalité après le congé
étaient observés chez les jeunes femmes vs les jeunes hommes. Nous avons réexaminé cette question à partir des données contemporaines
de l’étude de cohorte prospective multicentrique GENESIS-PRAXY (Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome).
Méthodes
Mille deux cent treize patients provenant de 26 centres du Canada, des États-Unis
et de la Suisse étaient inscrits à l’étude GENESIS-PRAXY entre janvier 2009 et avril
2013. Nous avons évalué les événements cardiaques indésirables majeurs (ECIM) et la
mortalité dans les 12 mois suivant le SCA. Le rôle du sexe en tant que prédicteur
des résultats était déterminé par le modèle de régression à effet proportionnel de
Cox.
Résultats
Nous avons inclus 1163 patients ayant des données complètes. La survenue des ECIM
était respectivement de 9 % et de 8 % chez les femmes et chez les hommes (P = 0,75), et 1 % des femmes et des hommes mouraient durant le suivi. Dans les modèles
ajustés, il n’existait aucune différence dans le risque d’ECIM ou de mortalité. La
proportion de patients subissant une réhospitalisation toutes causes confondues était
plus élevée chez les femmes (13 %) que chez les hommes (9 %; P = 0,006), mais les taux de réhospitalisation pour un événement cardiaque étaient
similaires chez les deux sexes, quel que soit le type de SCA. La majorité des premières
réhospitalisations était classifiée comme étant liée à une cause cardiaque (69 %),
dont la douleur thoracique ou l’angine (28 %) et l’infarctus du myocarde (19 %) étaient
rapportés comme étant les raisons les plus fréquentes.
Conclusions
Les femmes étaient plus susceptibles que les hommes de subir une réhospitalisation
toutes causes confondues, mais non pour cause cardiaque. Contrairement aux études
précédentes, les hommes et les femmes montraient des résultats similaires concernant
la mortalité et les ECIM après 1 an.
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Article info
Publication history
Published online: September 25, 2016
Accepted:
May 10,
2016
Received:
March 22,
2016
Footnotes
See editorial by Sedlak and Izadnegahdar, pages 1375–1377 of this issue.
See page 1452 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
