Elevated Mortality Risk in Women With Acute Coronary Syndrome

Female sex and young age can be linked to higher mortality in acute coronary syndrome (ACS) vs men, according to research presented at the 66th Annual Scientific Session & Expo of the American College of Cardiology.

Researchers from the University of Bologna in Italy examined data from 14,931 female patients with ACS enrolled in the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (ClinicalTrials.gov identifier: NCT01218776). The study aimed to assess characteristics and outcomes of young patients with ACS. The primary end point was ST segment elevation myocardial infarction (STEMI) as an index event and 30-day all-cause mortality.

More than 1100 enrollees (8%) were aged 45 years or younger (mean age, 40.3 years). The investigators identified STEMI as the “most common” clinical manifestation of ACS among younger patients (68% vs 59.6% in older patients). In addition, younger patients were found to have higher incidence of insignificant coronary disease (7.6% vs 5.4%) and single vessel disease (67% vs 52.5%); however, 3-vessel disease was less common (7.7% vs 16.3%). Unadjusted 30-day survival rates were 98.6% vs 93.1% for younger and older patients, respectively.

Adjustments were made for baseline characteristics, medications at time of admission, and invasive procedures. After those adjustments, the researchers noted that although being younger than 45 years of age was a predictor of survival in men (odds ratio [OR], 0.19; 95% CI, 0.07-0.48), the opposite was true for women (OR, 0.85; 95% CI, 0.36-2.04). 

Within the study population, general predictors of ACS were male sex (OR, 1.84), smoking status (OR, 2.29), familial history of coronary heart disease (OR, 1.72), and high body mass index (OR, 1.05).

“Factors underlying ACS in young patients and higher mortality rates in [the] female sex warrant further investigation,” the researchers concluded.

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Ricci B, Cenko E, Vasiljevic Z, et al. Acute coronary syndrome: the risk to be young and women. Abstract 1204-327. Presented at: the 66th Scientific Session & Expo of the American College of Cardiology. March 17-19, 2017; Washington, DC.