Acute coronary syndrome without ST segment elevation: Gender influence

Abstract

Despite the persistent perception that CAD is a man's disease, it is often the most common cause of death in women, responsible for 7 times more deaths than breast cancer. We led a retrospective, observational and monocentric study including 120 patients (70 men and 50 women) admitted for NSTE -ACS to the cardiology department “Adultes” at the university hospital la Rabta between January 2010 and December 2017. All epidemiological, clinical, therapeutic and prognostic data were compared in a gender perspective. It was observed that women were more often hypertensive, sedentary, obese and with less smoking rates than men. Presentation and symptoms of coronary artery disease in women are often atypical and misleading. Despite their higher ischemic risk (64% for women versus 37% for men with high risk criteria) ( P = 0,01), women seem to benefit less of invasive strategy. Coronary angiography when performed often shows non-obstructive coronary disease (16% in women versus 6% in men) and a coronary revascularization is less frequently proposed in women (67% versus 85%) ( P = 0,001). Women were generally more at risk for long-term events than men. They had more combined events (death/angina recurrence/revascularization) during the course of the evolution with a significant difference (68% in women versus 40% in men) ( P = 0,04) and a higher 1-year mortality rate. But at the end of our analysis, the female sex does not appear as an independent predictor of mortality at 1 year. In spite of its importance and major impact, CAD in women is under-diagnosed and often associated to higher risk criteria than men. Yet, women remain undertreated with less adequate therapeutic strategies responsible for a poorer prognosis in the long term and a higher mortality rate.