No gender difference in the clinical management and outcome of unstable angina.
BACKGROUND
Women with myocardial infarction have a less favorable prognosis than men. Many studies have indicated gender bias in the evaluation and treatment of myocardial infarction, but few data exist concerning these aspects in the management of unstable angina.


OBJECTIVE
To investigate gender differences in the baseline characteristics, clinical presentation, treatment and prognosis of women with unstable angina.


METHODS
Data were collected prospectively as part of the Acute Coronary Syndromes Israeli Survey in 2000 at Soroka University Medical Center. In-hospital management and 2 year follow-up were monitored for 226 consecutive patients with unstable angina admitted to our medical center during February and March 2000.


RESULTS
Women were older (71 +/- 12 vs. 66 +/- 12, P = 0.006), more diabetic (41.3% vs. 34.5%, not significant) and hypertensive (76.3% vs. 64.6%, P = 0.07). Women presented more often with atypical chest pain (18.8% vs. 7.5%, P = 0.038). Heparin, aspirin and angiotensin-converting enzyme inhibitor were delivered equally, but more beta-blockers were administered to women (88.5% vs. 75.7%, P = 0.02) and more statins to men (48.1% vs. 35.4%, P = 0.07). Angiography rates were similar (17.7% vs. 19.6%). Similar management was documented during the 2 year follow-up. Re-hospitalization rates were similar (53.3% of women and 63.7% of men, NS). Men had a tendency to develop acute myocardial infarction more often (9.6% vs. 2.7%, P = 0.06) and to develop peripheral vascular disease (3.7% vs. 0%, P = 0.09), and they had a non-significant higher rate of coronary artery bypass graft (6.7% vs. 1.3%, P = 0.08). No gender difference was found in angiography (14.7% of women vs. 16.3% of men) or percutaneous intervention (13% vs. 16.7%). At 2 years there was no gender-related difference in mortality (13.3% of women vs. 16.3% of , NS). Kaplan-Meier analysis for event-free survival after 2 years showed no gender difference in survival. Multi-regression analysis showed that gender was not a prognostic factor for survival.


CONCLUSIONS
We found no major difference in the management of men and women with unstable angina. Although men showed a tendency to suffer more major cardiac events, their 2 year prognosis was the same as for women.
Ben-Ami
Tal
T
Cardiology Division, Soroka University Medical Center, Beer Sheva, Israel.
Gilutz
Harel
H
Porath
Avi
A
Sosna
Gilat
G
Liel-Cohen
Noah
N
D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011287:Prejudice; D011379:Prognosis; D011446:Prospective Studies; D012737:Sex Factors