title: Revascularization and prognosis in female patients with non-ST-segment elevation acute coronary syndromes.
abstract: BACKGROUND
  After an acute myocardial infarction, women have a higher risk of death or reinfarction. In unstable angina, female gender seems to be protective. On the other hand, studies suggest that women are less frequently given coronary angiography.
  
  
  OBJECTIVE
  To evaluate, in our population of patients admitted for non-ST-elevation acute coronary syndrome (ACS), the influence of gender in prognosis and in the use of invasive procedures.
  
  
  METHODS
  We studied 387 consecutive patients, 20% female, admitted to our ICU for non-ST-segment elevation ACS. We compared demographic and clinical variables, the use of coronary angiography and myocardial revascularization procedures, according to gender. We analyzed the combined endpoint of death or (re)infarction at 30 days and for the total follow-up period of 420 +/- 322 days.
  
  
  RESULTS
  The women were older (65 +/- 10 vs. 62 +/- 11 years, p = 0.05), and more frequently had a history of hypertension (p = 0.005), diabetes mellitus (p = 0.07), previous surgical myocardial revascularization (p = 0.048) and higher heart rate on admission (p = 0.048). Smoking was more frequent in men (p < 0.001). The most frequent diagnosis was unstable angina; 76% for women vs. 66% in men (p = 0.12). Coronary angiography was performed during hospitalization in 87%, in both genders. Myocardial revascularization was performed in 62% of the women and 69% of the men (p = 0.26). At 30 days, the frequency of death or (re)infarction was 11% for women and 10% for men (log-rank, p = 0.79). By multivariate analysis (Cox regression), the independent predictors of outcome at 30 days were previous myocardial revascularization and heart failure on admission. For the total follow-up, we did not find differences in the occurrence of the combined endpoint, and the independent predictors of outcome were previous surgical myocardial revascularization, heart failure on admission, ST segment depression on the admission ECG and surgical myocardial revascularization.
  
  
  CONCLUSIONS
  In non-ST-elevation ACS, women present some differences in their demographic and clinical profile. We did not find differences in the use of invasive procedures or prognosis in the short and medium term.
authors.affiliation: Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide.
authors.forename: Ana Teresa
authors.initials: AT
authors.lastname: Timóteo
authors.forename: Jorge
authors.initials: J
authors.lastname: Ferreira
authors.forename: Carlos
authors.initials: C
authors.lastname: Aguiar
authors.forename: Manuel de Sousa
authors.initials: Mde S
authors.lastname: Almeida
authors.forename: Miguel Almeida
authors.initials: MA
authors.lastname: Ribeiro
authors.forename: Diogo Magalhães
authors.initials: DM
authors.lastname: Cavaco
authors.forename: Marisa
authors.initials: M
authors.lastname: Trabulo
authors.forename: Ricardo
authors.initials: R
authors.lastname: Seabra-Gomes
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008875:Middle Aged; D009204:Myocardial Revascularization; D011379:Prognosis; D012737:Sex Factors