GENDER DIFFERENCES IN THE INFLUENCE OF COMORBID CONDITIONS ON THE LONG-TERM OUTCOMES OF PATIENTS WITH ACUTE CORONARY SYNDROME

Abstract

Background. Gender differences in the baseline characteristics of patients with the acute coronary syndrome (ACS) have been widely acknowledged. Women are known to be generally older with a higher prevalence of comorbidities.

Objectives. Gender differences in the baseline characteristics of patients with the acute coronary syndrome (ACS) have been widely acknowledged. Women are known to be generally older with a higher prevalence of comorbidities. At the same time, it is now yet clear which comorbid conditions have the most significant impact on the long-term outcomes of patients with ACS and if there are any gender differences in this respect.

Methods. We performed a retrospective cohort study of 167 patients (109 men and 58 women) admitted to the acute coronary unit of Ternopil Municipal Hospital with ACS in 2016-2017. All relevant clinical information has been recorded in the pre-designed data charts. The incidence of repeated major adverse cardiovascular events (MACEs) has been assessed over 36 months after the hospital discharge via an e-Health electronic system.

Results. In this cohort, female patients with ACS had a higher prevalence of comorbid conditions: 15.5% of women vs. 11% of men with ACS had ≥5 comorbidities, 65.5% of women and 60% of men had 2-4 comorbid conditions, and 19% of women vs. 29% ≤1 concomitant disease. The comorbidity structure also differed between genders. Women more often had concomitant cerebrovascular diseases (17.2% vs. 7.3%, p=0.05), dementia (15.5% vs. 5.5 %, p=0.03), connective tissue disorders (17.25 vs. 6.42%, p=0.03) and thyroid disease (12.1% vs. 2.8%, p=0.02). Men more often suffered from peptic ulcer (13.7% vs. 3.4%, p=0.05). The incidence of MACEs during the follow-up period rose sharply with age and was higher in females (55% vs. 33%, p=0.003). In the multivariable model, PAD (OR 9.5, 95% CI: 1.7-52.3, p=0.01) and thyroid disease (OR 7.2, 95% CI: 1.19-43.2, p=0.03) demonstrated the most significant impact on the long-term event-free survival of females in the cohort. In turn, a solid metastatic tumor was the most significant predictor of poor prognosis in men (OR 6.3, 95% CI: 2.13-18.9, p=0.001).

Conclusions. We observed significant gender differences in the prevalence of comorbid conditions and their influence on the three-year event-free survival of patients with ACS. The predictive value of comorbidities should be further investigated, preferably, with the involvement of larger cohorts.