title: Impact of diagnosis and sex on long-term prognosis in acute coronary syndromes.
abstract: BACKGROUND
  There is limited information on long-term outcome in patients surviving the acute phase of an acute coronary syndrome (ACS). As yet, the effects of the type of syndrome and sex on mortality and morbidity in the long run have not been well described.
  
  
  METHODS
  We studied 1618 patients <80 years old with ACS and alive 30 days after hospitalization in a coronary care unit. The patients were followed for 5 years. They were divided into 4 groups according to the type of ACS (ST-segment elevation myocardial infarction [STEMI], non-STEMI, unstable angina pectoris high risk, and unstable angina pectoris low risk).
  
  
  RESULTS
  There was no significant sex difference in unadjusted 5-year mortality (P = .20). After adjustment for age, the hazard ratio with the corresponding 95% CI for a higher late 5-year mortality in women in relation to men was 0.89 (0.70-1.13, P = .34). Women were hospitalized for heart failure significantly more frequently during follow-up, a significance that disappeared after adjustment for age. Non-STEMI was associated with a significantly higher long-term mortality than STEMI, before but not after adjustment for covariates (hazard ratio [95% CI] 1.02 [0.75-1.37], P = .92). Of these, age, ST depression on admission, and early revascularization with percutaneous coronary intervention appeared to be of particular importance. Non-STEMI had a significantly higher rate of acute/subacute revascularization during follow-up, even after adjustment for age.
  
  
  CONCLUSIONS
  Before, but not after, adjustment for covariates, a diagnosis of non-STEMI was associated with a poorer prognosis than other types of ACS. Small sex differences in long-term outcome in survivors of ACS were found.
authors: Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden. elisabeth.perers@hjl.gu.se
authors: Elisabeth
authors: E
authors: Perers
authors: Kenneth
authors: K
authors: Caidahl
authors: Johan
authors: J
authors: Herlitz
authors: Thomas
authors: T
authors: Karlsson
authors: Marianne
authors: M
authors: Hartford
mesh_terms: D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality*; D011379:Prognosis; D012737:Sex Factors; D013577:Syndrome; D013997:Time Factors