Female Acute Coronary Syndrome Research Articles

Clinical Profile of Acute Coronary Syndrome in Females in a Tertiary Care Centre

Clinical Profile of Acute Coronary Syndrome in Females in a Tertiary Care Centre

Gender differences in acute coronary syndrome: experience from the Croatian branch of the ISACS-CT registry

Abstract Background and aim In recent years, worse outcomes of female acute coronary syndrome (ACS) patients have been recognized. The aim was to explore gender differences in ACS in the Croatian branch of the ISACS-CT registry (NCT01218776). Methods From January 2012 to May 2018, 3066 ACS patients were enrolled; 50% (n=1539) presenting with STEMI, 35% (n=1071) with NSTEMI, and 15% (n=456) with unstable angina (UA). In-hospital mortality was defined as the primary endpoint. Results At admission women were older, more burdened with comorbidities, with a longer delay from symptom onset to admission (Figure 1), but without differences in signs and symptoms or Troponin T levels (p=0.166). During hospitalization, there were no gender difference in the administration of beta blockers, ACE inhibitors or statins in the first 24 hours. Coronary angiography was performed in a smaller percentage of female patients (86 vs. 92%, p<0.001), however, the finding of no significant stenosis was more common in women (6 vs. 2%, p<0.001). Furthermore, less women underwent primary PCI (pPCI) (67 vs. 77%, p<0.001). While there were no gender differences in the number of the treated lesions (p=0.978), women had a higher incidence of procedural pPCI complications compared to men (13 vs. 8%, p=0.001) – predominantly due to higher occurrence of no reflow, side branch loss and new thrombus formation. Multivariate regression showed gender was not associated with the decision not to perform pPCI, whereas age over 65 years (OR=1.75), diabetes (OR=1.30), hypertension (OR=1.55), chronic kidney disease (OR=2.06) and the delay from onset of symptoms to admission >6h (OR=1.61) were associated. At discharge, there were no gender differences in LV ejection fraction <40% (p=0.259). Women with STEMI had significantly higher in-hospital mortality (10 vs. 4%, p<0.001), whereas no gender differences were seen regarding unstable angina and NSTEMI. After multivariate regression, only age over 65 years (OR=3.61), chronic kidney disease (OR=1.85) and primary PCI (OR=0.49) remained associated with in-hospital mortality. Conclusion The findings in the Croatian branch of the ISACS-CT registry demonstrate notable gender differences in ACS. Older age and a substantial burden of comorbidities represent strong influences on disease development, intervention choice and in-hospital mortality when treating women with ACS. Figure 1 Funding Acknowledgement Type of funding source: None

Spontaneous coronary artery dissection in young female acute coronary syndrome patients: a single-centre retrospective cohort study

Background Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome (ACS), rapidly gaining recognition over the last decade. SCAD occurs predominantly in young, otherwise healthy women and coronary angiogram often lacks typical (atherosclerotic) features. Therefore, SCAD remains notably underdiagnosed. As optimal treatment strategy differs greatly from atherosclerotic ACS, early (differential) diagnosis is crucial. Purpose/Methods In this paper, all coronary angiograms performed for ACS in women up to 50 years of age were retrospectively reviewed by three independent interventional cardiologists. Results The obtained insights are comparable to recent literature. SCAD incidence was 26% in this cohort. Left anterior descending coronary artery was the main affected vessel with SCAD subtype 2B as predominant angiographic presentation. Correct diagnosis during index procedure was poor with only 33% accuracy. Nevertheless, a favourable trend over time was noted. Percutaneous coronary intervention success was 56%, as in 44% of patients initial stenting was complicated by progressive dissection. Overall, outcome was excellent with no reported fatalities. Conclusion SCAD remains an underdiagnosed subtype of ACS and the importance of increasing awareness amongst (interventional) cardiologists needs to be emphasised.

P1569Spontaneous coronary artery dissection in young female acute coronary syndrome patients; a single-centre retrospective data analysis

P1569Spontaneous coronary artery dissection in young female acute coronary syndrome patients; a single-centre retrospective data analysis

Effects of gender on treatment strategies for elderly patients with acute coronary syndrome

To explore the effects of gender on treatment strategies for elderly patients with acute coronary syndrome (ACS). March 2009 to March 2012, consecutive 619 aged ACS patients undergoing coronary angiography (CA) were screened at our hospital. There were 273 females and 346 males. Risk factors, ACS diagnosis, CA results, treatments and prognosis were compared between female and male groups. The risk factors of body mass index, stroke history, smoking history, hemoglobin (Hb), serum cholesterol (TC), low density lipoprotein (LDL-C) and blood uric acid (UA) levels were significantly lower in female group than those in male group (P < 0.05). The morbidity of diabetes in female group was obviously higher than that in male group (27.8% vs 18.5%, P < 0.05). The prevalence of myocardial infarction history, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) history in male group were significantly greater than that in female group (48.0% vs 39.9%, P < 0.05; 30.6% vs 22.3%, P < 0.05; 19.9% vs 10.3%, P < 0.01). The rate of combined multiple risk factors (3 or higher) increased significantly in female group (41.8% vs 29.8%, P < 0.05). The incidence of unstable angina pectoris (UAP) and non-ST segment elevation myocardial infarction (NSTEMI) in female group was greater, but there was no statistical significance. The rate of 3-vessel and calcification lesions in female group was significantly elevated compared with male group (36.26% vs 28.61%, P < 0.05). Regarding the choice of treatment strategy, conservative treatment was common in females, but there was no statistical significance between them. PCI, emergency PCI and selective CABG operation were performed more frequently in female group compared with male group (26.0% vs 14.2%, P < 0.01; 14.7% vs 6.6%, P < 0.01; 19.1% vs 7.7%, P < 0.01). The prognosis had no statistical significance between two groups. The treatment strategies have certain limitations for female ACS patients. And an more aggressive treatment should be offered to improve the prognosis.