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Tytuł:
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Association of Sex with Outcome in Elderly Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.
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Autorzy:
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De Rosa R; University Hospital 'San Giovanni di Dio e Ruggi d'Aragona,' Salerno, Italy; Goethe University Hospital Frankfurt, Frankfurt am Main, Germany.
Morici N; ASST Grande Ospedale Metropolitano Niguarda, Milan; Department of Clinical Sciences and Community Health, Università degli Studi di Milo, Milan, Italy.
De Luca G; Azienda Ospedaliera Universitaria Maggiore della Carità, Eastern Piedmont University, Novara, Italy.
De Luca L; Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy.
Ferri LA; San Raffaele Scientific Institute, Milan, Italy.
Piatti L; Manzoni Hospital, Lecco, Italy.
Tortorella G; Ospedale Vaio, Fidenza, Italy.
Grosseto D; Ospedale Infermi, Rimini, Italy.
Franco N; Ospedale Infermi, Rimini, Italy.
Misuraca L; Ospedale della Misericordia, Grosseto, Italy.
Sganzerla P; ASST Bergamo ovest-ospedale di Treviglio, Treviglio, Italy.
Cacucci M; Ospedale Maggiore, Crema, Italy.
Antonicelli R; IRCCS Istituto Nazionale di Ricerca e Cura per l'Anziano, Ancona, Italy.
Cavallini C; Ospedale S. Maria della Misericordia, Perugia, Italy.
Lenatti L; Manzoni Hospital, Lecco, Italy.
Leuzzi C; IRCCS Arcispedale S. Maria Nuova, Reggio Emilia.
Murena E; Ospedale S. Maria delle Grazie, Pozzuoli, Italy.
Ravera A; University Hospital 'San Giovanni di Dio e Ruggi d'Aragona,' Salerno, Italy.
Ferrario M; IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy.
Corrada E; Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.
Colombo D; Clinical Pharmacology, Milan, Italy.
Prati F; Ospedale S. Giovanni-Addolorata, Roma, Italy.
Piscione F; University Hospital 'San Giovanni di Dio e Ruggi d'Aragona,' Salerno, Italy.
Petronio AS; Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Galasso G; University Hospital 'San Giovanni di Dio e Ruggi d'Aragona,' Salerno, Italy.
De Servi S; University of Pavia, Italy.
Savonitto S; Manzoni Hospital, Lecco, Italy. Electronic address: .
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Corporate Authors:
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Italian Elderly ACS Collaboration
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Źródło:
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The American journal of medicine [Am J Med] 2021 Sep; Vol. 134 (9), pp. 1135-1141.e1. Date of Electronic Publication: 2021 May 08.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: New York, NY : Excerpta Medica
Original Publication: New York, Donnelly.
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MeSH Terms:
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Acute Coronary Syndrome*/diagnosis
Acute Coronary Syndrome*/mortality
Acute Coronary Syndrome*/surgery
Percutaneous Coronary Intervention*/methods
Percutaneous Coronary Intervention*/statistics & numerical data
Risk Assessment*/methods
Risk Assessment*/statistics & numerical data
Sex Factors*
Aged ; Female ; Humans ; Hypertension/epidemiology ; Italy/epidemiology ; Male ; Mortality ; Overweight/epidemiology ; Prognosis ; Risk Factors ; ST Elevation Myocardial Infarction/diagnosis ; ST Elevation Myocardial Infarction/epidemiology ; Severity of Illness Index
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Contributed Indexing:
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Keywords: Acute coronary syndrome; Elderly; Percutaneous coronary intervention
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Entry Date(s):
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Date Created: 20210510 Date Completed: 20210909 Latest Revision: 20210909
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Update Code:
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20240105
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DOI:
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10.1016/j.amjmed.2021.03.025
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PMID:
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33971166
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Background: Worse outcomes have been reported for women, compared with men, after an acute coronary syndrome (ACS). Whether this difference persists in elderly patients undergoing similar invasive treatment has not been studied. We investigated sex-related differences in 1-year outcome of elderly acute coronary syndrome patients treated by percutaneous coronary intervention (PCI).
Methods: Patients 75 years and older successfully treated with PCI were selected among those enrolled in 3 Italian multicenter studies. Cox regression analysis was used to assess the independent predictive value of sex on outcome at 12-month follow-up.
Results: A total of 2035 patients (44% women) were included. Women were older and most likely to present with ST-elevation myocardial infarction (STEMI), diabetes, hypertension, and renal dysfunction; men were more frequently overweight, with multivessel coronary disease, prior myocardial infarction, and revascularizations. Overall, no sex disparity was found about all-cause (8.3% vs 7%, P = .305) and cardiovascular mortality (5.7% vs 4.1%, P = .113). Higher cardiovascular mortality was observed in women after STEMI (8.8%) vs 5%, P = .041), but not after non ST-elevation-ACS (3.5% vs 3.7%, P = .999). A sensitivity analysis excluding patients with prior coronary events (N = 1324, 48% women) showed a significantly higher cardiovascular death in women (5.4% vs 2.9%, P = .025). After adjustment for baseline clinical variables, female sex did not predict adverse outcome.
Conclusions: Elderly men and women with ACS show different clinical presentation and baseline risk profile. After successful PCI, unadjusted 1-year cardiovascular mortality was significantly higher in women with STEMI and in those with a first coronary event. However, female sex did not predict cardiovascular mortality after adjustment for the different baseline variables.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
