SPC365

Ladies first: awareness for the risk of adverse outcomes of female patients after ST-segment elevation acute coronary syndrome

Session: Posters (Sessão 6 - Écran 7) - Enfarte miocárdio elevação ST
Speaker: Mariana Martinho

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.7 Acute Coronary Syndromes - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Mariana Martinho; Rita Calé; Alexandra Briosa; Ernesto Pereira; Ana Rita Pereira; João Grade Santos; Bárbara Marques Ferreira; Diogo Santos Cunha; Pedro Santos; Sílvia Vitorino; Cátia Eusébio; Gonçalo Morgado; Cristina Martins; Hélder Pereira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Although male sex is considered a risk factor for cardiovascular (CV) disease, female patients are at higher risk of early mortality after ST-segment elevation acute coronary syndrome (STE-ACS). Evidence suggests that this is due to older age in women, higher rates of comorbidities and less primary revascularization (PCI). Data regarding long-term CV outcomes in women is conflicting and evidence for young patients (pts) is scarce. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> Comparison of short and long-term adverse outcomes according to gender after STE-ACS in a cohort of younger (<span style="font-family:Symbol">&pound;</span>55y) and older (&gt;55y) pts.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Retrospective observational single-center study of consecutive pts with STE-ACS submitted to PCI within the first 48h of symptom onset, between 2010 and 2015. Pt delay, door-to-balloon (D2B) and reperfusion delay were evaluated. Adverse outcomes were defined as 30-day all-cause mortality, 5y all-cause mortality and 5yMACE (composite endpoint of death, reinfarction, heart failure hospital admission and ischemic stroke). Survival analysis was performed according to the Kaplan-Meier method and differences stratified by gender were assessed using the log-rank test. A propensity score matching for CV risk factors was performed to obtain a well-balanced subset of male and female individuals.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> A total of 884pts were included: mean age 62&plusmn;13y; 26.9% females. Females were older (67&plusmn;14y vs 60&plusmn;12y, p&lt;0.001), higher rates of hypertension, diabetes and history of stroke. Men had more smoking habits and more previous coronary artery disease. Clinical severity at presentation was higher for females (Killip-kimball,KK class <span style="font-family:Symbol">&sup3;</span>2: 16.4% vs 10.3%, p=0.032). Delay to PCI did not differ between groups in the overall population, although young females had significantly higher D2B time than young males (95.0<span style="font-family:Symbol">[</span>66.0-210.0<span style="font-family:Symbol">]</span>min vs 80.0<span style="font-family:Symbol">[</span>59.0-108.5<span style="font-family:Symbol">]</span>, p=0.007). Success of PCI was similar between gender (95.7% vs 97.5%, p=0.261). At a mean FUP of 71&plusmn;36months, women had higher risk of 30day all-cause mortality (11.8% vs 4.6%, HR 2.76<span style="font-family:Symbol">[</span>1.60-4.75<span style="font-family:Symbol">]</span>, p=&lt;0.001), 5y death (32.1% vs 16.9%, HR 2.33<span style="font-family:Symbol">[</span>1.65-3.28<span style="font-family:Symbol">]</span>, p&lt;0.001) and 5yMACE (34.2% vs 19.8%, HR 2.10<span style="font-family:Symbol">[</span>1.51-2.92<span style="font-family:Symbol">]</span>, p&lt;0.001). After propensity matching, female sex was no longer associated with higher KK class but continued to be an independent predictor of adverse outcomes. This was also verified for matched pts &gt;55y. For younger pts, female sex increased 5yMACE but not 30-day or long-term mortality. Survival curves are displayed in figure 1.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> Although coronary artery disease is more prevalent in males, it seems that in a contemporary clinical practice females have higher risk of long-term CV events and death after STE-ACS submitted to PCI, even after multivariable correction for potential confounders. These findings highlight the need for raising awareness of CV disease in women and their need for stricter surveillance after a STE-ACS.</span></span></p>