title: Sex-Related Outcomes in Elderly Patients Presenting With Non-ST-Segment Elevation Acute Coronary Syndrome: Insights From the Italian Elderly ACS Study.
abstract: OBJECTIVE
  This study sought to investigate sex-related differences in treatment and outcomes in elderly patients with non-ST-segment elevation acute coronary syndromes (NSTEACS).
  
  
  BACKGROUND
  Female sex and older age are usually associated with worse outcome in NSTEACS. The Italian Elderly ACS study enrolled NSTEACS patients aged 75 years of age and older in a randomized trial comparing an early aggressive with an initially conservative strategy and in a registry of patients with ≥1 exclusion criteria of the trial.
  
  
  METHODS
  We compared sexes in the pooled populations of the trial and registry.
  
  
  RESULTS
  A total of 645 patients (313 from the trial and 332 from the registry), including 301 women (47%), were enrolled. Women were slightly older than men (82.1 ± 5.0 years vs. 81.2 ± 4.5 years; p = 0.02), had lower hemoglobin levels (12.5 ± 1.6 g/dl vs. 13.3 ± 1.9 g/dl; p < 0.001), and underwent fewer coronary revascularizations during the index admission (37.2% vs. 45.0%; p = 0.04). In-hospital adverse event rates were similar in both sexes; severe bleeding was uncommon (0.3% vs. 0%). The 1-year primary endpoint (composite of death, nonfatal myocardial infarction, disabling stroke, cardiac rehospitalization, and severe bleeding) occurred less often in women (27.6% vs. 38.7%; p < 0.01). Women not undergoing revascularization showed a 3-fold higher mortality, both in-hospital (8.5% vs. 2.7%; p = 0.05) and at 1 year (21.6% vs. 8.1%; p = 0.002).
  
  
  CONCLUSIONS
  Elderly women had a similar in-hospital outcome and better 1-year outcome compared with men. Coronary revascularization in women was associated with lower 1-year mortality, without an increase in severe bleeding. Elderly women with NSTEACS should always be considered for early revascularization.
authors.affiliation: Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. Electronic address: marcodecarlo@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.affiliation: First Division of Cardiology, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Nuccia
authors.initials: N
authors.lastname: Morici
authors.affiliation: Division of Cardiology, Ospedale Manzoni, Lecco, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Savonitto
authors.affiliation: Division of Cardiology, Ospedale S. Maria delle Grazie, Pozzuoli, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Grassia
authors.affiliation: Department of Cardiology, Ospedale S Maria della Misericordia, Perugia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Sbarzaglia
authors.affiliation: INRCA, Ancona, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Tamburrini
authors.affiliation: Department of Cardiology, Ospedale S Maria della Misericordia, Perugia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cavallini
authors.affiliation: Division of Cardiology, Ospedale Morgagni-Pierantoni, Forlì, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Galvani
authors.affiliation: Division of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Ortolani
authors.affiliation: Cure Intensive Coronariche, IRCCS Policlinico S. Matteo, Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.affiliation: Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: A Sonia
authors.initials: AS
authors.lastname: Petronio
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000401:mortality; D018579:Patient Selection; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: acute coronary syndromes; elderly; revascularization; sex