Estrategia de tratamiento inicial en el síndrome coronario agudo sin elevación del segmento ST. ¿Influye el género en la evolución a largo plazo?

Abstract

Introduction and objectiveThe outlook for ischemic heart disease may vary according to gender. We studied the progress of patients at high risk of acute coronary syndrome with non-ST elevation myocardial infarction (NSTE-ACS) (high Troponin I levels and/or changes in electrocardiogram findings) by gender and initial treatment strategy. MethodsRetrospective study of 398 patients (32.6% female) admitted between January 2006 and January 2009. We monitored their clinical features, treatment and major cardiovascular incidents over the course of 43 months on average (IC25-75 36-51). ResultsThere were no major differences between male and female patients when applying an invasive strategy (56.1% vs 61.5%, P=.3), coronary catheterisation (71.5% vs 78%, P=.2) or revascularisation (83% vs 80%, P=.7). There were no differences in the primary objective (cardiovascular death, non-fatal infarction and ictus) between male and female patients (16.9 vs 13.4%, P=.39). The invasive strategy proved effective in the primary objective (10.5% vs 21.2%, p=0.01), in both women (10.9% vs 24.5%, P=.04) and men (10.3% vs 19.4%, P=.03). In the multivariate analysis, full revascularisation was an independent predictor of less serious events (HR 0.29; IC 95%, 0.08-0.95, P=.04). ConclusionsThe long term progress of NSTE-ACS patients at high risk did not prove any differences according to gender. Like men, women with high-risk NSTE ACS benefited from an invasive strategy. Also, the complete revascularisation showed better prognosis than the incomplete revascularisation during the monitoring.