title: Influence of female sex on long-term mortality after acute coronary syndromes treated by percutaneous coronary intervention: a cohort study of 7304 patients.
abstract: OBJECTIVE
  Female sex has been associated with worse outcome after percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). We assessed the influence of female sex on the long-term outcome of patients undergoing PCI for ACS. This included an unadjusted analysis and a fully-adjusted multivariate analysis including a propensity score.
  
  
  METHODS
  This was an observational cohort study involving 7304 patients who had PCI for ACS [ST-elevation myocardial infarction (STEMI), non-ST elevation (NSTE) ACS] between October 2003 and September 2010. We analysed the effect of female sex on outcome.
  
  
  RESULTS
  The primary end point was all-cause mortality, which was obtained from the UK Office of National Statistics at a median follow-up of 3.2 years (IQR: 1.5-4.6). Women were significantly older and had higher rates of diabetes mellitus compared with men. Over long-term follow-up, mortality was significantly higher in women with ACS compared with men; as a whole [all ACS: odds ratio (OR) 1.351, P<0.001] or when analysed by ACS type (NSTE ACS: OR 1.260, P=0.009; STEMI: OR 1.625, P<0.001). However, after adjustment using multivariate analysis, female sex was not an independent predictor of mortality in any ACS group (all ACS: OR 0.978, P=0.772; NSTE ACS: OR 0.954, P=0.603; STEMI: OR 1.081, P=0.567). This observation remained after the incorporation of a propensity score into the multivariate analysis [OR 0.95, 95% confidence interval 0.82-1.10].
  
  
  CONCLUSIONS
  Women presenting with ACS were older and had more baseline comorbidities. Female sex, however, does not appear to be an independent risk factor for mortality in our cohort.
authors.affiliation: Department of Cardiology, London Chest Hospital, Bart's Health NHS Trust, London, UK. drtompain@googlemail.com
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Pain
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Jones
authors.forename: Krishnaraj S
authors.initials: KS
authors.lastname: Rathod
authors.forename: Sean M
authors.initials: SM
authors.lastname: Gallagher
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Knight
authors.forename: Anthony
authors.initials: A
authors.lastname: Mathur
authors.forename: Martin T
authors.initials: MT
authors.lastname: Rothman
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Jain
authors.forename: Andrew
authors.initials: A
authors.lastname: Wragg
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology