LONG-TERM RESULTS OF INVASIVE AND NON-INVASIVE MANAGEMENT STRATEGIES OF ACUTE CORONARY SYNDROME IN MALE VS FEMALE PATIENTS
DOI:
https://doi.org/10.11603/1811-2471.2022.v.i2.13139Keywords:
acute coronary syndrome, survival, prognosis, women, menAbstract
SUMMARY. The purpose of the work is to investigate the influence of the strategy of treatment of acute coronary syndrome on the long-term prognosis of women compared to men.
Material and Methods. We analyzed the long-term survival of 167 patients (109 men and 58 women) with acute coronary syndrome. Clinical endpoints were sudden or unexplained death and readmission for AMI or unstable angina. The analysis of adverse cardiovascular events was carried out through the e-Health system of the Ternopil Communal City Hospital No. 2. The total observation period was 36 months.
Results. According to the obtained results, women had a significantly higher risk of recurrent adverse cardiovascular events during the next 3 years after ACS than men (OR 2.67, 95 % CI: 1.39–5.15). The probability of future adverse events in patients increased dramatically with age. According to the results of multivariate analysis, an invasive treatment strategy (PCV/CABG) was associated with a better prognosis in both men (OR 0.29, 95 % CI: 0.14–0.62) and women (OR 0.48, 95 % CI: 0.09–2.63). Instead, conservative management of GCS was associated with a significantly worse prognosis in male (OR 3.85, 95 % CI: 3.75–8.48) and female (OR 2.97, 95 % CI: 1.14–7.75) patients) sex. Kaplan-Meier cumulative survival curve analysis did not show significant gender differences in the prognosis of patients who received invasive GCS treatment (log-rank (Mantel-Cox) test: c2=3.69, p=0.054) or medical treatment (log-rank ( Mantel-Cox) test: c2=2.6, p=0.1).
Conclusions. An invasive strategy for the treatment of GCS is reliably associated with a better long-term prognosis of patients of both sexes, while conservative management of GCS was correlated with worse event-free survival. The benefit of invasive treatment in women, as well as in men, is indisputable and this fact should be taken into account when choosing a management strategy for ACS in clinical practice.
References
Polewczyk, A., Janion, M., & Polewczyk, M. (2013). Acute Coronary Syndromes in Women-Gender Specific Changes in Coronarography.
Chieffo, A., Buchanan, G.L., Mauri, F. (2012). ACS and STEMI treatment: gender-related issues. EuroIntervention, 8, P, P27-P35. DOI:10.4244/EIJV8SPA6.
De Carlo, M., Morici, N., & Savonitto, S. (2015). Sex-Related Outcomes in Elderly Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome: Insights From the Italian Elderly ACS Study. JACC Cardiovasc Interv., 8(6), 791-796. DOI:10.1016/j.jcin.2014.12.240.
Hao, K., Takahashi, J., & Ito, K. (2015). Clinical Characteristics of Patients With Acute Myocardial Infarction Who Did Not Undergo Primary Percutaneous Coronary Intervention- Report From the MIYAGI-AMI Registry Study. Circ J., 79(9), 2009-2016. DOI:10.1253/circj.CJ-15-0440.
Shehab, A., Al-Dabbag, B., AlHabib, K.F. (2013). Gender disparities in the presentation, management and outcomes of acute coronary syndrome patients: data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2). PLoS One, 8(2), e55508. DOI:10.1371/journal.pone.0055508.
Yu, J., Mehran, R., & Grinfeld, L. (2015). Sex-based differences in bleeding and long term adverse events after percutaneous coronary intervention for acute myocardial infarction: three year results from the HORIZONS-AMI trial. Catheter. Cardiovasc. Interv., 85(3), 359-368. DOI:10.1002/ccd.25630.
Khan, E., Brieger D., & Amerena, J. (2018). Differences in management and outcomes for men and women with ST-elevation myocardial infarction. Med. J. Aust., 209(3), 118-123.
Anand, S.S., Xie, C.C., & Mehta, S. (2005). Differences in the management and prognosis of women and men who suffer from acute coronary syndromes. J. Am. Coll. Cardiol., 46(10), 1845-1851. DOI:10.1016/j.jacc.2005. 05.091.
Lee, K.K., Ferry, A.V., & Anand, A. (2019) Sex-Specific Thresholds of High-Sensitivity Troponin in Patients With Suspected Acute Coronary Syndrome. J. Am. Coll. Cardiol., 74(16), 2032-2043. DOI:10.1016/j.jacc.2019.07.082.
Lunova, T., Komorovsky, R., & Klishch, I. (2022). Gender Differences in Treatment Delays, Management and Mortality among Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. Current Cardiology Reviews. Advance online publication. DOI: 10.2174/1573403X18666220630120259.
Hiteshi, A.K., Li, D., Gao, Y., Chen, A., Flores, F., Mao, S.S., & Budoff, M.J. (2014). Gender differences in coronary artery diameter are not related to body habitus or left ventricular mass. Clinical Cardiology, 37(10), 605-609.
Tian, J., Wang, X., Tian, J., & Yu, B. (2019). Gender differences in plaque characteristics of nonculprit lesions in patients with coronary artery disease. BMC Cardiovascular Disorders, 19(1), 45.
Hellings, W.E., Pasterkamp, G., Verhoeven, B.A., De Kleijn, D.P., De Vries, J.P., Seldenrijk, K.A., van den Broek, T., & Moll, F.L. (2007). Gender-associated differences in plaque phenotype of patients undergoing carotid endarterectomy. Journal of Vascular Surgery, 45(2), 289-297.
(2020). Sex and Gender in Cardiovascular Medicine: Presentation and Outcomes of Acute Coronary Syndrome. Eur. Heart J.;41:1328-1336.
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