Female Acute Coronary Syndrome Patients Research Articles

Association of the triglyceride glucose-body mass index with the extent of coronary artery disease in patients with acute coronary syndromes

BackgroundStudies have shown that insulin resistance is strongly associated with the development of cardiovascular disease, and the triglyceride glucose-body mass index (TyG-BMI index) is considered to be a reliable surrogate marker of insulin resistance. There are limited studies on the relationship between TyG-BMI index and the extent of coronary artery disease in patients with acute coronary syndrome (ACS). This study aimed to investigate the relationship between TyG-BMI index and the extent of coronary artery disease in patients with ACS.MethodsOverall, 2,317 patients with ACS who underwent percutaneous coronary intervention at the Affiliated Hospital of Zunyi Medical University were included in this study. The TyG-BMI index was grouped according to the tertile method. The extent of coronary artery disease in patients with ACS was quantitatively assessed using the SYNTAX score, which was categorised as low (≤ 22), intermediate (23–32), and high risk (≥ 33).ResultsIn the overall population, multivariate logistic regression analyses showed that TyG-BMI index was associated with mid/high SYNTAX score in patients with ACS (odds ratio [OR] = 1.0041; 95% confidence interval [CI] = 1.0000–1.0079; p = 0.0310). Subgroup analyses showed that TyG-BMI index was an independent risk factor for mid/high SYNTAX score in female ACS patients after adjusting for multiple confounders (OR = 1.0100; 95% CI = 1.0000–1.0200; p = 0.0050), and that the risk of mid/high SYNTAX score was 2.49 times higher in the T3 group (OR = 2.4900; 95% CI = 1.2200–5.0600; p = 0.0120). Restricted cubic spline analysis showed a linear correlation between TyG-BMI index and complex coronary artery disease (SYNTAX score > 22) in women with ACS. In female ACS patients, inclusion of the TyG-BMI index did not improve the predictive power of the underlying risk model (net reclassification improvement: 0.0867 [-0.0256–0.1989], p = 0.1301; integrated discrimination improvement: 0.0183 [0.0038–0.0329], p = 0.0135).ConclusionsTyG-BMI index is linearly associated with the degree of complex coronary artery disease in female ACS patients. However, the inclusion of the TyG-BMI index did not improve the predictive power of the underlying risk model for female ACS patients.

Abstract 18970: Sex Differences and In-Hospital Outcomes of Acute Coronary Syndrome Among Patients With Mediastinal Radiation Exposure: Insights From the National Inpatient Sample (2009-2020)

Background There is a paucity of data about the sex disparities and temporal trends in outcomes of Acute Coronary Syndrome (ACS) patients with prior mediastinal radiation. Methods: The National Inpatient Sample database years 2009 to 2020 was queried for ACS hospitalizations of patients with prior mediastinal radiation. The primary outcome was MACCE (major cardiovascular events) and secondary outcomes included other hospital cardiovascular outcomes including hospital resource utilization. Results: A total 23385 hospitalizations for ACS with prior mediastinal radiation exposure were identified. Females accounted for 15904 (68.01%) of the cases. Median age was 70 vs 72 and the majority of the cases were whites 82.79% vs 78.22% for females and males respectively. Cases were mostly non-ST elevation MI in both genders 75.98% vs 79.71% while ST-elevation MI represented 24.02% vs 20.29% of them. Female patients with ACS had a higher burden of hypertension, diabetes mellitus, hyperlipidemia and obesity, however, males had a higher burden of Peripheral vascular disease, chronic heart failure and smoking. After propensity matching, primary outcome related to MACCE was higher in males (aOR1.803, 95%CI (1.65-1.96)) along with cardiogenic shock (aOR: 1.77, 95%CI (1.55-2.02)) and Mechanical Circulatory Support (MCS) use (aOR: 1.48, 95%CI (1.29 -1.71)). Similar findings were noted after the subgroup analysis in STEMI and NSTEMI where males had the worst In-hospital outcomes compared to females. Overall, we observed an increasing trend in ACS hospitalizations among females from 2.85% in 2009 to 7.91% in 2020 however, mortality decreased over the years from 8.69% in 2009 to 3.51% in 2020. Conclusions: This nationwide observational analysis showed significant disparities and burden of cardiovascular comorbidities among male and female ACS patients with prior mediastinal radiation history, with higher hospitalization rates among females but higher mortality among males.

Angiographic Finding in Acute Coronary Syndrome in Female Patient’s Diabetic vs Non-Diabetic

Background: From January 2018 to July 2018, a study was conducted at Hayatabad Medical Complex's Department of Cardiology to analyze the angiographic results of female patients admitted for acute coronary syndrome (ACS). The study group consisted of 75 female patients with ACS; thirty patients were diabetic, while the remaining forty-five were non-diabetic. Results from angiography revealed that single vessel disease (36.67%) was the most common finding in non-diabetic patients, followed by two vessel disease (31.11%). The study found that disease severity in diabetic patients varied more, with the majority (43.33%) having two vessel disease. Single vessel disease (33.33%) and three vessel disease (23.33%) were also frequently observed. Conversely, non-diabetic patients displayed more normal coronaries (44.44%) while diabetic patients tended to have more diseased vessels (66.67%). Ultimately, the study determined that female diabetics with ACS exhibit a wider range of complex diseases compared to their non-diabetic counterparts. Objectives: From January 2018 to July 2018, Department of Cardiology at Hayatabad Medical Complex in Peshawar received admissions for acute coronary syndrome (ACS) in both diabetic and non-diabetic female patients. Our present study aims to compare the findings of their angiograms. Methodology: The present study had 75 female patients admitted to Hayatabad Medical Complex's Cardiology Department between January and July 2018 for ACS. Medical records were reviewed for age, medical history, and angiography findings. A comparison of non-diabetic and diabetic patients showed 45 and 30 patients, respectively. The severity of the ACS was determined by the number of vessel involvement and coronary artery status in the angiography report. Results: Single vessel disease was identified as the most common finding in 36.67% of non-diabetic patients, while two vessel disease was noted in 31.11%. However, in diabetic patients, the most frequent discovery was two vessel disease with 43.33%, followed by single vessel disease in 33.33% and three vessel disease in 23.33%. In terms of coronary artery status, more non-diabetic patients had normal coronaries (44.44%) in contrast to diabetic patients who showed more diseased vessels with a percentage of 66.67%. Conclusion: The study revealed a greater range and complexity of illness severity among female ACS patients with diabetes than those without. This indicates that those with diabetes are more susceptible to severe ACS forms, underscoring the importance of their careful monitoring to minimize the chances of cardiovascular complications. Keywords: ACS, Angiography, Diabetic, Non-Diabetic, Coronary Artery.

Sex differences in the management of patients with acute coronary syndrome: A population-based ecological cross-sectional study in Spain

Introduction and objectivesDespite evidence of a reduction in the incidence and mortality of acute coronary syndrome (ACS), some studies have highlighted differences in outcomes between men and women. We aimed to explore sex differences in the management and treatment of patients with ACS in Spain. MethodsThis ecological cross-sectional study combined ACS data from 10 Spanish registries (54 centres). Meta-regression analysis was performed using aggregated data of baseline characteristics, interventional procedures, treatments, and events that occurred during hospitalization and one-year follow-up. ResultsAggregated data from 34605 patients (75.1% men) was included. ST-segment elevation myocardial infarction was the most frequent diagnosis (58.9%) and almost 80% of patients were Killip Class I. Compared to men, women were older (mean age: 71.0 vs 63.3 years) and presented higher rates of hypertension (68.1% vs 51.7%) and diabetes (37.7% vs 26.5%). Women were also less likely to undergo percutaneous coronary interventions, revascularization surgery, and to receive drug-eluting stents during hospitalization. Regarding to antiplatelet therapy, even though indicated, 23.1% of women were not treated with P2Y12 inhibitors (vs 14.2% of men; P<.001); clopidogrel was the most frequently administered agent (> 60%). Significantly higher in-hospital (5.4% vs 3.7%) and 1-year (8.2% vs 4.9%) mortality was observed among women compared to men, which was mainly attributed to cardiovascular causes. ConclusionsDespite older age and unfavourable risk profile, female ACS patients seem to be suboptimally treated with P2Y12 inhibitors. To reduce mortality associated with ACS, improved prevention and optimized therapeutic approaches are needed.

Smoking and Provision of Smoking Cessation Interventions among Inpatients with Acute Coronary Syndrome in China: Findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project.

HighlightsOver half of male acute coronary syndrome patients were smokers in China.Smoking was associated with higher risk of critical cardiac symptoms at admission.Only 35.3% of smoking patients received smoking cessation interventions in China.Background:Smoking cessation is recognized as an effective and cost-effective strategy for improving the prognosis of patients with coronary heart disease. Despite this, few studies have evaluated the smoking prevalence and provision of smoking cessation interventions among patients with acute coronary syndrome (ACS) in China.Objectives:To evaluate the smoking prevalence, clinical conditions and in-hospital outcomes associated with smoking, and the provision of smoking cessation interventions among ACS patients in China.Methods:This registry study was conducted using data from the Improving Care for Cardiovascular Disease in China project, a collaborative nationwide registry of the American Heart Association and the Chinese Society of Cardiology. Our study sample comprised 92,509 ACS inpatients admitted between November 2014 and December 2018. A web-based data collection platform was used to report required data.Results:Smoking prevalence among male and female ACS patients was 52.4% and 8.0%, respectively. Patients younger than 45 years had the highest smoking rate (men: 68.0%; women: 14.9%). Compared with non-smokers, smokers had an earlier onset age of ACS and a greater proportion of severe clinical manifestations at admission, including ST-elevation myocardial infarction (67.8% versus 54.8%; p < 0.001) and substantially elevated myocardial injury markers (86.1% versus 83.0%; p < 0.001). After multivariable adjustment, smoking was associated with higher risk of critical cardiac symptoms at admission (OR = 1.14, 95% CI: 1.08–1.20; p < 0.001) and had no direct association with in-hospital outcomes (OR = 0.93, 95% CI: 0.84–1.02; p = 0.107) of ACS patients. Of 37,336 smokers with ACS, only 35.3% received smoking cessation interventions before discharge. There was wide variation in provision of smoking cessation interventions across hospitals (0%–100%).Conclusions:Smoking is highly prevalent among ACS patients in China. However, smoking cessation interventions are not widely adopted in clinical practice in China as part of formal treatment strategies for ACS patients, indicating an important target for quality improvement.Clinical Trial Registration:URL: http://www.clinicaltrials.gov. Unique identifier: NCT02306616.

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.

Abstract 241: An Investigation of Sex Differences in the BRIDGE Transitional Care Clinic Population

Background: Although cardiovascular disease (CVD) is the leading cause of death in men and women, women are less likely than men to received certain evidence-based treatments for CVD or be enrolled in CVD clinical trials. This study sought to identify sex differences in outcomes among patients referred to the BRIDGE transitional care clinic following hospitalization for a cardiac event. Methods: Retrospective data on patients referred to BRIDGE from 2008-2016 were analyzed. Demographics and outcomes (readmissions, emergency department [ED] visits, death) were compared between male and female patients in five populations: 1) the total BRIDGE population, 2) acute coronary syndrome (ACS) patients, 3) congestive heart failure (CHF) patients, 4) atrial fibrillation/flutter (AF) patients, and 5) patients who attended BRIDGE clinic. Results: Of 4159 patients, 1710 (41.1%) were female. In the total population, women were significantly older than men (66.8 v 64.8, p=0.010), were less likely to be married (45.2% v 68.2%, p≤0.001), and had higher Charlson Comorbidity Index (CCI) scores (4.90 v 4.60, p=0.001). Women were also less likely to have ACS (20.7% v 28.6%, p≤0.001), more likely to have CHF (25.1% v 20.9%, p=0.001), and were more likely to have an ED visit within 6 months post-discharge. No significant differences were seen in outcomes between males and females in the CHF and AF populations; however, female ACS patients were more likely to have had an ED visit within 6 months of discharge than male ACS patients. In regards to transitional care, women were less likely to attend their BRIDGE appointment (68.7% v 72.4%, p=0.008). Among BRIDGE attendees, females were older (66.8 v 64.9, p=0.001), less likely to be married (45.9% v 68.8%, p=0.001), and had higher CCI scores (4.80 v 4.55, p=0.016) than males. Female attendees were more likely than male attendees to have had an ED visit both within 30 days and 6 months. Conclusions: Among the total population, BRIDGE attendees, and ACS patients, women were more likely to visit the ED than men. Additionally, women were less likely than men to attend their BRIDGE transitional care appointment. Efforts should be made to improve BRIDGE clinic attendance among women and develop targeted strategies to improve outcomes for female patients, specifically those with a primary diagnosis of ACS.

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

Female Psychological Adjustment Following an Acute Coronary Syndrome.

The outcomes of cardiovascular disease are consistently worse among women, regardless of age or disease severity.Such trend might arise from psychosocial factors, which should be examined in this population. Obective: To evaluate the influence of type-D personality on anxiety and depression symptoms reported by female patients after afirst acute coronary syndrome. As part of a larger study, 34 female patients with a first acute coronary syndrome were compared with 43controls on psychosocial measures (Hospital Anxiety and Depression Scale; type-D personality, DS - 14). Hypertension (p < 0.001), diabetes (p < 0.05), dyslipidemia (p < 0.05), type-D personality (p = 0.001) and anxiety (p < 0.001)were more prevalent among patients. Exercise (p < 0.05) and antidepressant use (p < 0.05) were more common among controls.Logistic regression analysis confirmed that higher prevalence of hypertension (p < 0.05), dyslipidemia (p < 0.05), type-D personality (p <0.05), anxiety (p < 0.05) and less antidepressant use (p < 0.05), were independently associated with acute coronary syndrome. Type-Dpersonality was associated with higher Hospital Anxiety and Depression Scale scores in controls (anxiety: p = 0.001; depression: p <0.001) but not in patients. High anxiety after an acute coronary syndrome might reflect a short-term adaptive response, albeit worsening the diseaselong-term prognosis. The lack of differences in some group comparisons (patients versus controls for depression scores; type-D'positive' versus type-D 'negative' for anxiety and depression scores within patients) is discussed. Type-D personality, high anxiety, hypertension and dyslipidemia seem to cluster among female acute coronary syndromepatients. Nevertheless, type-D personality itself was not associated with higher anxiety and depressive scores during the post-acuteperiod.

Treatment and outcomes of acute coronary syndromes in women: An analysis of a multicenter quality improvement Chinese study

BackgroundVariations in care and outcomes by sex in patients with acute coronary syndrome (ACS) have been reported worldwide. The aims of this study are to describe ACS management according to sex in China and the effects of a quality improvement program in Chinese male and female ACS patients. Methods and resultsClinical Pathways for Acute Coronary Syndromes - Phase 2 (CPACS-2) was a cluster randomized trial to test whether a clinical pathways-based intervention would improve ACS management in China. The study enrolled 15,141 hospitalized patients [4631 (30.6%) were women] from 75 hospitals throughout China between October 2007 and August 2010. The intervention included clinical pathway implementation and performance measurement using standardized indicators with 6 monthly audit-feedback cycles. Eight key performance indicators reflecting in hospital management of ACS were measured. After adjustment for differences in patient characteristics and comorbidities at presentation, women were significantly less likely to undergo coronary angiography when indicated (RR 0.88 [0.85 to 0.92], P<0.001), less likely to receive guideline recommended medical therapies at discharge (RR 0.94 [0.91 to 0.98], P=0.003) and more likely to be hospitalized for shorter (mean difference −0.42 [−0.73 to −0.12] days, P=0.007). However, in-hospital clinical outcomes did not differ by sex. There was no evidence of heterogeneity in the relative effects of the quality improvement initiative by sex. ConclusionsSex disparities were apparent in some key quality of care indicators for patients with suspected with ACS presenting to hospitals in China. The beneficial effect of the quality improvement program was consistent in women and men. Clinical trial registrationhttp://www.anzctr.org.au/default.aspx. Unique identifier: ACTRN12609000491268.

Endothelial lipase plasma levels are increased in both sexes in stable coronary artery disease and only in women with acute coronary syndrome but not associated with the severity of coronary artery disease.

To investigate whether endothelial lipase (EL) plasma levels are increased in stable coronary artery disease (sCAD) and acute coronary syndrome (ACS) patients, as well as to test the association of EL plasma levels and the severity of CAD and sex. The study was performed as a single-center, cross-sectional, observational research on 72 sCAD and 187 ACS patients in the Sisters of Charity University Hospital Centre, Zagreb, Croatia, between December 1, 2011 and December 1, 2012. EL plasma levels were measured using ELISA. EL plasma levels were significantly higher in sCAD patients (median 311.3 pg/mL, interquartile range [IQR] 250.4-422.6 pg/mL) than in ACS patients (median=258.7 pg/mL, IQR=162.1-356.0 pg/mL; P<0.001). EL levels in female ACS patients were significantly higher (median 314.5 pg/mL, IQR 218.3-420.8 pg/mL) than in male ACS patients (median 225.4 pg/mL, IQR 148.7320.1 pg/mL; P<0.001) and similar to the EL levels in the sCAD patients. There was no significant correlation between EL plasma levels and the GENSINI score and between EL plasma levels and the number of atherosclerotic coronary artery segments in either the ACS (rho=-0.09, P=0.247; rho=0.12, P=0.106, respectively) or sCAD group (rho=0.04, P=0.771; rho=0.06, P=0.643, respectively). Our results suggest that EL plasma levels discriminate male but not female patients with different clinical presentations of CAD, as well as female and male ACS patients. EL plasma levels are not significantly correlated with CAD severity.

Circulating Angiogenic Factors at the Time of Acute Coronary Syndrome in Women With Prior Preeclampsia

Epidemiological studies have established a strong positive association between preeclampsia and future development of cardiovascular disease; however, the molecular determinants underlying this association have not been well defined. Here, we sought to evaluate the circulating levels of several known angiogenic biomarkers in women with premature acute coronary syndrome (ACS) with and without prior preeclampsia, and to determine whether these markers are associated with post ACS complications. We studied 233 parous women (mean age 48.5 years ±5.8) with ACS, and divided them into three groups based on a prior history of normotensive pregnancy (n=160), preeclampsia (n=32), and gestational hypertension (n=41). We measured plasma protein levels of 3 key biomarkers previously implicated in endothelial dysfunction including soluble fms like tyrosine kinase (Sflt1), placental growth factor (PIGF) and endoglin, using ELISA/Luminex assays. Cox proportional hazard models were used to assess whether these biomarkers were associated with major adverse events (recurrent ACS, percutaneous coronary intervention, coronary artery bypass graft, or cardiovascular death) 12 months post ACS. At the time of ACS, women with prior preeclampsia were younger (46.3 ± 6.5 yrs vs 49.5 ± 4.9 yrs, p=0.0015), and were more likely to have chronic hypertension (n=29 (88%) vs. n=63 (38%), p<0.001) than were women with prior normotensive pregnancy. The proportion of ACS patients with sflt1/PIGF ratios exceeding the 75th percentile was significantly higher (p=0.03) in women with prior preeclampsia (n=12; 38%) versus prior normotensive pregnancy (n=30;19%). There was no significant difference in soluble endoglin levels between groups, and none of the biomarkers were associated with major adverse cardiovascular events 12 months following ACS. Elevated circulating levels of endoglin and the ratio of sflt1/PIGF have previously been reported in women with preeclampsia, reflecting a pathologic imbalance in pro and antiangiogenic factors. In the current study, none of these biomarkers predicted future adverse cardiac events in female ACS patients; however, a significantly higher proportion of the patients with prior preclampsia versus normotensive pregnancy showed extreme sflt1/ PIGF ratios (>75th percentile). These data provide novel insight into the underlying molecular dysregulation that may contribute to increased ischemic heart disease risk following preeclampsia.

Abstract 15833: Circulating MicroRNAs Provide Insight Into Potential Molecular Links Between Hypertensive Disorders of Pregnancy and Cardiovascular Disease

Introduction: Hypertensive disorders of pregnancy, such as preeclampsia and gestational hypertension, are strong sex-specific risk factors for cardiovascular disease (CVD). The molecular determinants underlying this risk have not been clearly defined, but potentially involve sustained vascular damage and/or dysfunction. This may be reflected by alterations in the levels of specific circulating microRNA (miRNA). Study Objective: To identify miRNAs that circulate at different levels in women diagnosed with acute coronary syndrome (ACS), with and without a prior history of preeclampsia or gestational hypertension. Methods: The present study is a derivation cohort of women with a diagnosis of premature (age &lt; 55 yrs) ACS, divided into three groups based on a prior history of gestational hypertension, preeclampsia, or normotensive pregnancy (n=11-13/group). The three groups were closely matched on potential confounding variables including age, chronic hypertension, diabetes, smoking status and type of ACS. Total RNA was extracted from citrate plasma of each participant, and the relative levels of 372 miRNAs were measured by high-density PCR array. Measurements and analyses were performed blinded to exposure status. Results: The circulating levels of 16 miRNAs were significantly (p&lt;0.05) altered in the preeclampsia versus normotensive pregnancy groups (from -2.8 fold down to +2.0 fold change), and 32 miRNAs were significantly altered between the gestational hypertension and normotensive pregnancy groups (from -2.8 to +2.7 fold change). These miRNAs showed little to no overlap with previously published reports of circulating miRNAs that were altered acutely at the time of preeclamptic pregnancy or ACS event. Several priority candidates have previously been functionally annotated, including miRNAs linked to angiogenesis (miR-126-3p), inflammation (miR-146a-5p), and cholesterol metabolism (miR-122-5p). Conclusions: Circulating levels of multiple miRNAs were altered between female ACS patients with and without prior hypertensive disorders of pregnancy. These miRNAs provide novel insight into the potential molecular pathways that may contribute to vascular dysfunction and risk of CVD.

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.

Gender Differences in Self-Reported Symptoms of Depression among Patients with Acute Coronary Syndrome

This study examined the prevalence of self-reported depressive symptoms and the self reported somatic depressive symptoms as measured by the Beck Depression Inventory-II (BDI-II) among patients hospitalized for acute coronary syndrome (ACS), and explored the impact of gender on both. A convenience sample of 789 adults (248 women and 541 men) was recruited for the study during hospital admission for ACS and participants were screened for self-reported depressive symptoms. BDI-II scores of ≥14 indicate a moderate level of depressive symptoms and this cut-off score was used to categorize patients into depressed and non-depressed groups. Pearson chi-square tests for independence (categorical variables) and t tests for independent samples (continuous variables) were used for gender comparisons. Results showed that depressive symptoms during ACS episodes were different between women and men. Women reported greater overall depressive symptoms (BDI-II mean = 11.89, S.D. = 9.68) than men (BDI-II mean = 9.00, S.D. = 7.93) (P < 0.000). Significantly more women (7.66%) were identified positive for somatic depressive symptoms (sleep and appetite disturbances and fatigue) than men (2.22%) (P = 0.0003). Findings support that there are gender differences in depressive symptoms experienced by patients hospitalized for ACS. Somatic symptoms of depression may be important indicators of depression especially among female ACS patients.

Gender differences in coronary plaque components in patients with acute coronary syndrome: Virtual histology-intravascular ultrasound analysis

The aim of this study was to evaluate the gender differences in plaque components in acute coronary syndrome (ACS) patients. We used virtual histology-intravascular ultrasound to evaluate the plaque components in culprit lesions in 362 ACS patients (254 men, 108 women). Women were more likely to be diabetic (34% vs 23%, p=0.030), had greater percentage necrotic core (%NC) volume (19.0±12.7% vs 16.8±11.9%, p=0.040), and had trends toward higher high-sensitivity C-reactive protein (hs-CRP) (0.85±1.28 mg/dl vs 0.53±0.48 mg/dl, p=0.063), and higher incidence of thin-cap fibroatheroma (TCFA) (62% vs 52%, p=0.078) compared with men. %NC volume was significantly greater in diabetic patients compared with nondiabetic patients (20.4±10.2% vs 16.0±8.9%, p<0.001) and was significantly greater in patients with elevated hs-CRP (≥0.2 mg/dl) compared with those with normal hs-CRP (<0.2 mg/dl) (18.8±8.9% vs 16.6±9.7%, p=0.021). However, there were no differences in plaque components between diabetic women and men, and between women and men with elevated hs-CRP levels. Diabetes [odds ratio (OR): 2.44, 95% confidence interval (CI): 1.35-3.82, p=0.003] and hs-CRP (OR: 1.54, 95% CI: 1.08-2.65, p=0.032), but not female gender, were the independent predictors of TCFA. Although it seems likely that female ACS patients have more vulnerable plaque components compared with male ACS patients, these findings may result not from true gender differences in plaque components but higher prevalence of diabetes and hs-CRP elevation in women.

The prevalence and correlates of mind-body therapy practices in patients with acute coronary syndrome

While the benefits of mind-body therapy (MBT) for cardiac secondary prevention continues to be investigated, the prevalence of such practices by cardiac patients is not well known. The aim of this study was to quantitatively examine the prevalence of MBT practice and its sociodemographic, clinical, psychosocial and behavioral correlates among patients with acute coronary syndrome (ACS). Six hundred and sixty-one ACS in-patients (75% response rate) recruited from three hospitals completed a demographic survey, and clinical data were extracted from charts. Four hundred and sixty five patients (81% retention rate; 110 (23.7%) female) responded to an 18-month post-discharge survey that queried about MBT use and its correlates. One hundred and sixty-three (35.1%) ACS patients practised MBT in their lifetime, and 118 (25.4%) were currently practising. MBT users were more often women (OR = 2.98), nonwhite (OR = 2.17), had higher levels of education (OR = 2.22), past smokers (OR = 3.33), reported poorer mental health (OR = 2.15), and engaged in more exercise (OR = 1.65). One-third of ACS patients practised some form of MBT. The greater MBT practice among female ACS patients is noteworthy, given their generally lower physical activity and lower receipt of evidence-based treatments including cardiac rehabilitation. In addition, there is some evidence that MBT can promote mental well-being, and thus such practice might reduce risk related to negative affect in cardiac patients.