Sex Differences in Clinical Outcomes After Premature Acute Coronary Syndrome.
Over past decades, the incidence of acute coronary syndrome (ACS) has increased in young women, and greater mortality rates after discharge were observed among young women vs men. We revisited this issue with contemporary data from the Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome (GENESIS-PRAXY), a multicentre prospective cohort study.



One thousand two hundred thirteen patients were enrolled in GENESIS-PRAXY from 26 centres across Canada, the United States, and Switzerland between January 2009 and April 2013. We assessed major adverse cardiac events (MACE) and mortality over 12 months after ACS. The role of sex as a predictor of outcomes was determined with Cox proportional hazard regression analysis.



We included 1163 patients with complete data. The occurrence of MACE was 9% and 8% in women and men, respectively (P = 0.75), and 1% of women and men died during follow-up. In adjusted models, there was no sex difference in the risk of MACE or mortality. The proportion of patients with all-cause rehospitalization was higher in women (13%) compared with men (9%; P = 0.006), but cardiac rehospitalization rates were similar in both sexes regardless of ACS type. Among first rehospitalizations, the majority was classified as cardiac related (69%), with chest pain or angina (28%) and myocardial infarction (19%) reported as the most common reasons for first rehospitalization.



Women were more likely than men to be rehospitalized for all causes but not for a cardiac cause. In contrast to earlier studies, men and women had similar mortality and MACE outcomes at 1 year.
Divisions of Clinical Epidemiology and General Internal Medicine, The Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
Roxanne
R
Pelletier
Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Jin
J
Choi
Divisions of Clinical Epidemiology and General Internal Medicine, The Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
Nicholas
N
Winters
Divisions of Cardiology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.
Mark J
MJ
Eisenberg
Department of Exercise Science, Concordia University, Montréal, Québec, Canada.
Simon L
SL
Bacon
Division of Cardiology, Department of Medicine and Department of Community Health and Epidemiology, Halifax, Nova Scotia, Canada.
Jafna
J
Cox
Division of General Internal Medicine, Department of Medicine, McGill University, McGill University Health Centre, Montréal, Québec, Canada.
Stella S
SS
Daskalopoulou
Department of Psychology, University of Québec in Montréal, Montréal, Québec, Canada.
Kim L
KL
Lavoie
Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
Igor
I
Karp
Division of Cardiology, Soroka Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel.
Avi
A
Shimony
Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Derek
D
So
Division of Cardiology, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.
George
G
Thanassoulis
Divisions of Clinical Epidemiology and General Internal Medicine, The Research Institute of the McGill University Health Centre, Montréal, Québec, Canada. Electronic address: louise.pilote@mcgill.ca.
Louise
L
Pilote
D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality / Q000628:therapy; D000328:Adult; D000367:Age Factors; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013557:Switzerland / Q000453:epidemiology; D014481:United States / Q000453:epidemiology