title: Sex and Ethnic Differences in Outcomes of Acute Coronary Syndrome and Stable Angina Patients With Obstructive Coronary Artery Disease.
abstract: BACKGROUND
  The joint contribution of sex, ethnicity, and initial clinical presentation to the long-term outcomes of patients undergoing coronary angiography for acute coronary syndrome (ACS) or stable angina, in whom there is angiographic evidence for obstructive coronary artery disease, remains unknown.
  
  
  RESULTS
  We conducted a population-based cohort study on 49 556 adult ACS or stable angina patients with angiographic evidence of obstructive coronary artery disease (≥ 50% stenosis) in British Columbia. The 2-year composite outcome was all-cause death and hospital readmissions for myocardial infarction, heart failure, cerebrovascular accident, or angina after the index angiography. Sex and ethnic differences in the composite outcome were examined by clinical presentation using the Cox proportional-hazards and logistic regression models. Overall, 25.6% were women, 9.5% were South Asians, 3.0% were Chinese, and 65.9% presented with ACS. Regardless of ethnicity, women were more likely than men to have adverse outcomes, but the magnitude of the sex difference was greater in the ACS patients (P(interaction) for sex and clinical presentation=0.03). Angina readmission accounted for 45% of the composite outcome and was the main component for all groups with the exception of Chinese women with ACS. Furthermore, women were more likely than men to be readmitted for angina (odds ratio [95% confidence interval], 1.13 [1.04-1.22]).
  
  
  CONCLUSIONS
  Higher rates of adverse events among women with obstructive coronary artery disease, regardless of ethnicity, as well as high rates of angina readmission, highlight the need for more targeted interventions to reduce the burden of angina because this presentation is clearly not benign.
authors.affiliation: From the Division of Cardiology (M.I., K.H.H.), School of Nursing (M.M.), and Vancouver General Hospital, Leslie Diamond Women's Heart Health Clinic (T.L.S.), University of British Columbia, Canada; Heart Centre (M.M.) and Providence Health Care Research Institute (M.M., M.K.L., K.H.H.), St. Paul's Hospital, British Columbia, Canada; BC Centre for Improved Cardiovascular Health, British Columbia, Canada (M.I., M.K.L., M.G., K.H.H.); Centre for Health Evaluation and Outcomes Research, Canada (M.M., K.H.H.); and Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.).
authors.forename: Mona
authors.initials: M
authors.lastname: Izadnegahdar
authors.affiliation: From the Division of Cardiology (M.I., K.H.H.), School of Nursing (M.M.), and Vancouver General Hospital, Leslie Diamond Women's Heart Health Clinic (T.L.S.), University of British Columbia, Canada; Heart Centre (M.M.) and Providence Health Care Research Institute (M.M., M.K.L., K.H.H.), St. Paul's Hospital, British Columbia, Canada; BC Centre for Improved Cardiovascular Health, British Columbia, Canada (M.I., M.K.L., M.G., K.H.H.); Centre for Health Evaluation and Outcomes Research, Canada (M.M., K.H.H.); and Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.).
authors.forename: Martha
authors.initials: M
authors.lastname: Mackay
authors.affiliation: From the Division of Cardiology (M.I., K.H.H.), School of Nursing (M.M.), and Vancouver General Hospital, Leslie Diamond Women's Heart Health Clinic (T.L.S.), University of British Columbia, Canada; Heart Centre (M.M.) and Providence Health Care Research Institute (M.M., M.K.L., K.H.H.), St. Paul's Hospital, British Columbia, Canada; BC Centre for Improved Cardiovascular Health, British Columbia, Canada (M.I., M.K.L., M.G., K.H.H.); Centre for Health Evaluation and Outcomes Research, Canada (M.M., K.H.H.); and Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.).
authors.forename: May K
authors.initials: MK
authors.lastname: Lee
authors.affiliation: From the Division of Cardiology (M.I., K.H.H.), School of Nursing (M.M.), and Vancouver General Hospital, Leslie Diamond Women's Heart Health Clinic (T.L.S.), University of British Columbia, Canada; Heart Centre (M.M.) and Providence Health Care Research Institute (M.M., M.K.L., K.H.H.), St. Paul's Hospital, British Columbia, Canada; BC Centre for Improved Cardiovascular Health, British Columbia, Canada (M.I., M.K.L., M.G., K.H.H.); Centre for Health Evaluation and Outcomes Research, Canada (M.M., K.H.H.); and Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.).
authors.forename: Tara L
authors.initials: TL
authors.lastname: Sedlak
authors.affiliation: From the Division of Cardiology (M.I., K.H.H.), School of Nursing (M.M.), and Vancouver General Hospital, Leslie Diamond Women's Heart Health Clinic (T.L.S.), University of British Columbia, Canada; Heart Centre (M.M.) and Providence Health Care Research Institute (M.M., M.K.L., K.H.H.), St. Paul's Hospital, British Columbia, Canada; BC Centre for Improved Cardiovascular Health, British Columbia, Canada (M.I., M.K.L., M.G., K.H.H.); Centre for Health Evaluation and Outcomes Research, Canada (M.M., K.H.H.); and Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.).
authors.forename: Min
authors.initials: M
authors.lastname: Gao
authors.affiliation: From the Division of Cardiology (M.I., K.H.H.), School of Nursing (M.M.), and Vancouver General Hospital, Leslie Diamond Women's Heart Health Clinic (T.L.S.), University of British Columbia, Canada; Heart Centre (M.M.) and Providence Health Care Research Institute (M.M., M.K.L., K.H.H.), St. Paul's Hospital, British Columbia, Canada; BC Centre for Improved Cardiovascular Health, British Columbia, Canada (M.I., M.K.L., M.G., K.H.H.); Centre for Health Evaluation and Outcomes Research, Canada (M.M., K.H.H.); and Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.).
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
authors.affiliation: From the Division of Cardiology (M.I., K.H.H.), School of Nursing (M.M.), and Vancouver General Hospital, Leslie Diamond Women's Heart Health Clinic (T.L.S.), University of British Columbia, Canada; Heart Centre (M.M.) and Providence Health Care Research Institute (M.M., M.K.L., K.H.H.), St. Paul's Hospital, British Columbia, Canada; BC Centre for Improved Cardiovascular Health, British Columbia, Canada (M.I., M.K.L., M.G., K.H.H.); Centre for Health Evaluation and Outcomes Research, Canada (M.M., K.H.H.); and Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.). karin.humphries@ubc.ca.
authors.forename: Karin H
authors.initials: KH
authors.lastname: Humphries
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000208:ethnology; D000368:Aged; D060050:Angina, Stable / Q000150:complications* / Q000208:ethnology; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000208:ethnology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012727:Sex Characteristics
keywords: acute coronary syndrome; angina, stable; coronary artery disease; ethnology; outcome assessment (health care); sex