Current non-ST-elevation myocardial infarction (NSTEMI) guidelines suggest invasive management within 72 hours, although within this time frame, no optimal timing has been elucidated. Furthermore, women are less likely than men to receive standard of care therapies for acute coronary syndrome (ACS). However, no studies have analyzed the younger NSTEMI population, nor if optimal timing for early invasive management exists in men and women of this population. To assess sex differences in access to care among younger patients with NSTEMI, and to determine whether the timing of coronary angiography was associated with adverse cardiovascular outcomes in women and men. GENESIS PRAXY is an observational cohort study of patients with premature ACS (≤55 years). Three hundred and six patients with NSTEMI (117 women and 189 men) were stratified into 4 groups according to the delay between hospital presentation and coronary angiography (<24 hours, 24-48 hours, 48-72 hours, >72 hours). Outcomes at 12-month included major adverse cardiac events ([MACE], cardiac mortality, recurrent ACS, revascularization), and recurrent hospitalization. During the index hospitalization, women were less likely than men to receive percutaneous intervention (56% vs. 74%, p=0.001), ASA (93% vs. 98%, p=0.01), clopidogrel (70% vs. 83%, p<0.01) and statins (86% vs. 96%, p=001). Within 72 hours of presentation, women were less likely than men to receive angiography (70% vs. 84%, p<0.01 ). In sex-stratified analyses, among women, there was a trend toward an increased risk of MACE in patients receiving angiography between 48-72 hours from hospital presentation, compared to the 3 other groups (21% vs. 9%, 0%, and 6%, in the 48-72 , <24 hour, 24-48 hour, >72 hour groups, respectively, p=0.058). However, there was no group difference in the risk of rehospitalization (16%, 8%, 13% and 3%, respectively, p=0.31). Differently, among men, there was a trend toward an increased risk of MACE in those undergoing angiography after 72 hours, compared to the 3 other groups (17%, 5%, 6%, and 0%, in the >72 hour, <24 hour, 24-48 hour and 48-72 hour groups, respectively, p=0.053). Men receiving angiography after 72 hours also had an increased risk of recurrent hospitalization compared to the 3 other groups (20% vs. 3%, 6% and 0%, respectively, p<0.01). In younger adults with NSTEMI, women are less likely to receive standard of care therapies. Our results further suggest that optimal timing of angiography may differ between sexes.
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Sep 1, 2019
Julija Simpson + 2
Open Access
