Abstract
BackgroundSex influences outcome of patients with acute coronary syndrome (ACS). If there is a relationship between sex and physical performance is unknown.MethodsThe analysis is based on older (≥70 years) ACS patients included in the FRASER, HULK, and LONGEVO SCA prospective studies. Physical performance was assessed by Short Physical Performance Battery (SPPB). The primary outcome was all-cause mortality.ResultsThe study included 1388 patients, and 441 (32%) were women. At presentation, women were older and more compromised than men. After a median follow-up of 998 [730–1168] days, all-cause death occurred in 334 (24.1%) patients. At univariate analysis, female sex was related to increased risk of death. After adjustments for confounding factors, female sex was no longer associated with mortality. Women showed poor physical performance compared with men (p < 0.001). SPPB values emerged as an independent predictor of death. Including clinical features and SPPB in the multivariable model, we observed a paradigm shift in the prognostic role of female sex that becomes a protective factor (HR 0.73, 95% CI 0.56–0.96). Sex and physical performance showed a significant interaction (p = 0.03). For lower SPPB values (poor physical performance), sex-related changes in mortality were not recorded, while in patients with higher SPPB values (preserved physical performance), female sex was associated with better survival.ConclusionsTwo key findings emerged from the present real-life cohort of older ACS patients: (i) physical performance strongly influences long-term mortality; (ii) women with preserved physical performance have a better outcome compared to men.Trial registrationwww.clinicaltrials.gov NCT02386124 and NCT03021044
Highlights
Sex influences outcome of patients with acute coronary syndrome (ACS)
A recent analysis in patients admitted for myocardial infarction at young age (< 50 years) highlighted the poorer prognosis of women when compared to men [1]
The third study was the “Impacto de la Fragilidad y otros Síndromes Geriátricos en el Manejo y Pronóstico Vital del Anciano con Síndrome Coronario Agudo sin Elevación de Segmento ST” (LONGEVO SCA) registry. This was a multicenter registry conducted to assess the characteristics of 532 adults aged ≥80 years admitted to 44 Spanish hospitals with a diagnosis of non-ST segment elevation ACS in order to evaluate the effect of frailty on 6-month morality and mortality and readmission [13, 14]
Summary
Sex influences outcome of patients with acute coronary syndrome (ACS). Over the past few years, several studies investigated the intricate relationship between sex and long-term outcome after acute coronary syndrome (ACS) [2,3,4,5]. While in younger ACS patients, the discrepancies are mainly related to a different distribution of risk factors and comorbidities, in the older ones, the differences could be linked to important, but unrecognized prognostic factors, such as malnutrition, frailty, and physical performance [6]. The present study sought to evaluate if the adverse prognostic role of female sex is confirmed in a population of older (≥70 years) patients with ACS and how sex and physical performance interact to affect the outcome
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