title: Sex and age differences and outcomes in acute coronary syndromes.
abstract: BACKGROUND
  There is conflicting information about sex differences in presentation, treatment, and outcome after acute coronary syndromes (ACS) in the era of reperfusion therapy and percutaneous coronary intervention. The aim of this study was to examine presentation, acute therapy, and outcomes of men and women with ACS with special emphasis on their relationship with younger age (≤65years).
  
  
  METHODS
  From January 2010 to June 2015, we enrolled 5140 patients from 3 primary PCI capable hospitals. Patients were registered according to the International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC) registry protocol (ClinicalTrials.gov: NCT01218776). The primary outcome was the incidence of in-hospital mortality.
  
  
  RESULTS
  The study population was constituted by 2876 patients younger than 65years and 2294 patients older. Women were older than men in both the young (56.2±6.6 vs. 54.1±7.4) and old (74.9±6.4 vs. 73.6±6.0) age groups. There were 3421 (66.2%) patients with ST elevation ACS (STE-ACS) and 1719 (33.8%) patients without ST elevation ACS (NSTE-ACS). In STE-ACS, the percentage of patients who failed to receive reperfusion was higher in women than in men either in the young (21.7% vs. 15.8%) than in the elderly (35.2% vs. 29.6%). There was a significant higher mortality in women in the younger age group (age-adjusted OR 1.52, 95% CI: 1.01-2.29), but there was no sex difference in the older group (age-adjusted OR 1.10, 95% CI: 0.87-1.41). Significantly sex differences in mortality were not seen in NSTE-ACS patients.
  
  
  CONCLUSIONS
  In-hospital mortality from ACS is not different between older men and women. A higher short-term mortality can be seen only in women with STEMI and age of 65 or less.
authors.affiliation: Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia. Electronic address: zoranav@eunet.rs.
authors.forename: Zorana
authors.initials: Z
authors.lastname: Vasiljevic-Pokrajcic
authors.affiliation: Department for Prevention and Control of Non-Communicable Disease, Center for Prevention and Control of Diseases, Institute of Public Health of Serbia "Dr Milan Jovanović Batut", Belgrade, Serbia.
authors.forename: Natasa
authors.initials: N
authors.lastname: Mickovski
authors.affiliation: Clinical Centre Kragujevac, University Clinic, Medical Faculty Kragujevac, Serbia.
authors.forename: Goran
authors.initials: G
authors.lastname: Davidovic
authors.affiliation: Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia.
authors.forename: Milika
authors.initials: M
authors.lastname: Asanin
authors.affiliation: Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia.
authors.forename: Branislav
authors.initials: B
authors.lastname: Stefanovic
authors.affiliation: Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia.
authors.forename: Gordana
authors.initials: G
authors.lastname: Krljanac
authors.affiliation: Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia.
authors.forename: Mina
authors.initials: M
authors.lastname: Radosavljevic-Radovanovic
authors.affiliation: Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia.
authors.forename: Nebojsa
authors.initials: N
authors.lastname: Radovanovic
authors.affiliation: Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia.
authors.forename: Ratko
authors.initials: R
authors.lastname: Lasica
authors.affiliation: University of Belgrade, Institute for Medical Research, Department of Neurophysiology, Belgrade, Serbia.
authors.forename: Sladjan
authors.initials: S
authors.lastname: Milanović
authors.affiliation: University of Belgrade, Institute for Medical Research, Department of Neurophysiology, Belgrade, Serbia.
authors.forename: Jovana
authors.initials: J
authors.lastname: Bjekić
authors.affiliation: General Hospital "Dr Dragiša Mišović", Čačak, Serbia.
authors.forename: Marta
authors.initials: M
authors.lastname: Majstorovic-Stakic
authors.affiliation: Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia.
authors.forename: Danijela
authors.initials: D
authors.lastname: Trifunovic
authors.affiliation: Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia.
authors.forename: Ana
authors.initials: A
authors.lastname: Karadzic
authors.affiliation: Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia.
authors.forename: Dubravka
authors.initials: D
authors.lastname: Rajic
authors.affiliation: Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Milosevic
authors.affiliation: Clinical Centre, "Bezanijska Kosa", University of Belgrade, Medical Faculty, Belgrade, Serbia.
authors.forename: Marija
authors.initials: M
authors.lastname: Zdravkovic
authors.affiliation: Clinical Centre, "BezanijskaKosa", Belgrade, Serbia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Saric
authors.affiliation: Department of Experimental, Diagnostics and Specialty Medicine, University of Bologna, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Bugiardini
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D012727:Sex Characteristics; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Age differences; Outcomes; Sex differences