Abstract
Sex differences in patients with acute coronary syndrome (ACS) are a matter of debate. We investigated sex-specific differences in the incidence, outcomes, and related interventions in patients diagnosed with ACS in Germany over the past decade. All ACS cases from 2005 to 2015 were collected. Procedures and inhospital mortality were assessed by sex. Age-adjusted incidence rates were calculated. In total, 1,366,045 females and 2,431,501 males presenting with ACS were recorded. Females were older than males (73.1 vs. 66.4 years of age), had a longer mean hospital stay (7.7 vs. 6.9 days), and less frequently underwent coronary angiographies (55% vs. 66%) and coronary interventions (35% vs. 47%). The age-adjusted incidence rate of ACS was lower in females than in males, and decreased in both sexes from 2005 to 2015. The age-adjusted inhospital mortality rate was substantially higher in females than in males, but decreased in both sexes over time (in females, from 87 to 71 cases per 1000 person years; in males, from 57 to 51 cases per 1000 person years). In conclusion, we reported sex differences in the incidence, treatment, and outcomes of ACS patients in Germany within the past decade. Women had a substantially higher mortality rate and lower rate of coronary interventions.
Highlights
Every year, more than 20 million patients present to emergency departments in Europe and North America with suspected acute coronary syndrome (ACS) [1,2]
Data were exported on our behalf by the Research Data Center of the Federal Statistical Office and Statistical Offices of the Federal States in Wiesbaden, Germany, and aggregated statistics were provided on the basis of R codes that we supplied to the Research Data Center
We investigated all cases of patients with a main diagnosis of ACS (ICD Codes I20.0, I21 or I22) in Germany from 2005 to 2015
Summary
More than 20 million patients present to emergency departments in Europe and North America with suspected acute coronary syndrome (ACS) [1,2]. There have been substantial improvements in diagnostic and therapeutic options for patients with ACS, resulting in improved outcomes [3] These improvements include the evolution of high-sensitivity troponin assays that allow for faster and more accurate diagnostic pathways [4,5]. Primary and secondary prevention strategies have improved over time, and more sophisticated invasive strategies for treating ACS patients are available. These include the clinical application of routine coronary angiography with the possible use of modern stents, more efficient antiplatelet-therapy regimes, and the more widespread use of lipid-lowering treatments [3]. In addition to lower resource utilization among females [10,11,12,13], earlier studies reported worse outcomes in women, including a higher incidence of ACS-related mortality [11]
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