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Gender Differences in Outcomes Following Acute Coronary Syndrome in Young Adults
Session:
Sessão de Posters 50 - Doença coronária - diferenças demográficas
Speaker:
Pedro Mangas Palma
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Pedro Mangas Palma; Miguel Rocha; Helena Moreira; Luís Santos; Cátia Oliveira; Ana Pinho; André Cabrita; Catarina Marques; Joana Rodrigues; Afonso Rocha; Paula Dias; Rui Rodrigues
Abstract
<p><strong>Introduction</strong></p> <p>Acute coronary syndrome (ACS) is less frequent in young adults, but it has become a significant health problem associated with the increasing prevalence of modifiable risk factors. Evidence on the impact of gender on prognosis after ACS among younger adults is lacking.</p> <p><strong>Objectives</strong></p> <p>We evaluated gender differences in long-term cardiovascular outcomes after ACS in young adults.</p> <p><strong>Methods</strong></p> <p>We performed a retrospective single-centre cohort study which included all patients <55 years old who were referred to a cardiac rehabilitation program from 2010 to 2020. Clinical, echocardiographic and blood test data were recorded. The endpoint of study was major adverse cardiovascular events (MACE) - acute coronary syndrome, stroke, heart failure, all-cause and cardiovascular death. The effect of gender on the cumulative freedom from MACE was estimated using the Kaplan-Meier curves, log-rank test and a Cox proportional hazard model adjusted for clinically relevant characteristics.</p> <p><strong>Results</strong></p> <p>A total of 585 patients were included (75% male, with a mean age of 46.8 ± 6.14 years and a median follow-up of 5.25 years). At the time of diagnosis, women were less likely to smoke (69.9% vs 86.5%, p<0.001) and to have a previous coronary revascularization (11.8% vs 4.2%, p=0.009), but were more likely to have diabetes (20.3% vs 10.5%, p=0.003) and family history of premature coronary artery disease (CAD) (42.6% vs 31.9%, p=0.020). Men presented more frequently with ST elevation myocardial infarction (54.9% vs 36.4%, p< 0.001) and multivessel CAD (32.4% vs 18.0%, p<0.001).</p> <p>During follow-up, MACE occurred more frequently in women (27.2% vs 14.8%, p=0.001). ACS was the most frequent event in both genders (47.5% vs 36.9% in men, p=0.035), followed by cerebrovascular events (30.0% vs 24.6%, p= 0.544), heart faillure (10.0% vs 20.0%, p=0.178) and death (10.0% vs 18.5%, p=0.243). Kaplan-Meier survival curves showed that men had better survival compared to women (log-rank test p<0.001). Multivariate analysis with Cox regression also revealed that women had a higher risk of MACE (Hazard Ratio = 2.52, 95% confidence interval 1.47-3.42, p<0.001).</p> <p><strong>Conclusion</strong></p> <p>In young adults with ACS ocorrence of MACE was independently associated with the female gender. Further research is needed to unveil the physiological and biological processes leading to this gender disparity.</p>
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