title: Comparison of results of percutaneous coronary intervention for non-ST-elevation acute myocardial infarction or unstable angina pectoris in men versus women.
abstract: Previous randomized trials have addressed the impact of gender on outcomes, showing worse results in women assigned to invasive strategies compared with men with non-ST-elevation (NSTE) acute coronary syndrome (ACS). However, there is still a significant amount of controversy on strategies of treatment on the basis of gender. This study evaluated the impact of gender on treatment strategies and outcomes in patients with NSTE ACS in a high-volume, single-site tertiary center. We identified 1,197 consecutive patients with NSTE ACS (381 women, 816 men) who underwent percutaneous coronary intervention during their index hospitalizations. Patients were stratified by gender and baseline clinical and angiographic characteristics, and in-hospital and 9-month clinical outcomes were compared between the 2 groups. There were clear differences in baseline characteristics between men and women with ACS at presentation. Women were, on average, slightly older than men, with more hypertension and morbid obesity, but there were no differences in racial backgrounds or the prevalence of diabetes or dyslipidemia, nor were there treatment disparities in pharmacologic interventions. Women and men with ACS had similar rates of percutaneous coronary intervention on index admission. Women had a greater incidence of bleeding complications requiring blood transfusions. Overall, in-hospital and 9-month event-free survival were equivalent for the 2 genders. In conclusion, in this single-site observational study, patients with NSTE ACS who underwent angiography followed by percutaneous coronary intervention demonstrated no significant gender differences in treatment or in-hospital or 9-month event-free survival. From these results, interventional strategies should not be based on gender.
authors.affiliation: Division of Cardiology, The Henry Low Heart Center, Hartford Hospital, Hartford, and University of Connecticut School of Medicine, Farmington, USA. relkous@harthosp.org
authors.forename: Rachid A
authors.initials: RA
authors.lastname: Elkoustaf
authors.forename: Igor
authors.initials: I
authors.lastname: Mamkin
authors.forename: Jeff F
authors.initials: JF
authors.lastname: Mather
authors.forename: Deborah
authors.initials: D
authors.lastname: Murphy
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Hirst
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Kiernan
authors.forename: Raymond G
authors.initials: RG
authors.lastname: McKay
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D017678:Sex Distribution; D012737:Sex Factors; D016896:Treatment Outcome