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Canadian Journal of Cardiology

Sex Differences in Clinical Outcomes After Premature Acute Coronary Syndrome

Published:September 25, 2016DOI:https://doi.org/10.1016/j.cjca.2016.05.018

      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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