title: Sex-related differences in baseline characteristics, management and outcome in patients with acute coronary syndrome without ST-segment elevation.
abstract: OBJECTIVE
  To detect sex-related differences in baseline characteristics, management and outcome in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
  
  
  METHODS
  Data from 812 consecutive patients admitted to our cardiology department for NSTE-ACS between 2001 and 2004 were obtained. Early invasive therapy was defined as revascularization during first hospital stay. A seven-year follow-up for the clinical endpoint of all-cause mortality could be obtained in 342 women and 440 men, respectively.
  
  
  RESULTS
  Compared with men, women were significantly older and more likely to suffer from renal insufficiency. The proportion treated with clopidogrel at admission was 43.6% for women and 52.7% for men, respectively (p=0.011). Significantly fewer women underwent an early invasive therapy compared with men (27.5% vs. 35.2%; p=0.021). Age and renal insufficiency were the strongest predictors for a conservative approach in both female and male patients. After adjustment for baseline characteristics there was no significant difference in treatment between women and men (odds ratio 0.89; 95% confidence interval 0.59-1.35; p=0.588). While in-hospital mortality was similar between the sexes, long-term mortality was significantly higher in women compared with men (8.2% vs. 7.0%; p=0.549 for in-hospital mortality and 54.8% vs. 39.3%; p<0.001 for seven-year mortality). However, after adjustment for baseline characteristics and treatment there was no significant difference in long-term mortality between women and men (hazard ratio 1.14; 95% confidence interval 0.89-1.47; p=0.307).
  
  
  CONCLUSIONS
  In these patients with NSTE-ACS women were less likely to undergo an early invasive therapy compared with men due to their higher age and the higher rate of renal insufficiency. After adjustment for age, comorbidities and treatment female sex was not associated with worse long-term outcome.
authors.affiliation: 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria Birgit.Vogel@wienkav.at.
authors.forename: Birgit
authors.initials: B
authors.lastname: Vogel
authors.affiliation: 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Serdar
authors.initials: S
authors.lastname: Farhan
authors.affiliation: 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hahne
authors.affiliation: 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Ilyas
authors.initials: I
authors.lastname: Kozanli
authors.affiliation: 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Kalla
authors.affiliation: 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Matthias K
authors.initials: MK
authors.lastname: Freynhofer
authors.affiliation: 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Jarai
authors.affiliation: 3rd Medical Department, Division of Endocrinology and Metabolism, Medical University of Vienna, Austria.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kautzky-Willer
authors.affiliation: 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods; D019468:Disease Management; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D016016:Proportional Hazards Models; D012737:Sex Factors; D016896:Treatment Outcome
keywords: Acute coronary syndrome; early invasive treatment; long-term outcome; sex-related differences