A study, presented at the annual meeting of the Society for Cardiac Angiography and Interventions (4–7 May, Orlando, USA) and published in Catheterization and Cardiovascular Interventions, indicates that women aged less than 55 years with acute coronary syndrome undergoing percutaneous coronary intervention (PCI) have significantly greater comorbidities and worse outcomes than their male counterparts.
Writing in Catheterization and Cardiovascular Interventions, Jaya Chandrasekhar (Icahn School of Medicine, New York, USA) and others report that women with acute coronary syndromes “have historically worse outcomes compared with men”, noting than women presenting with the condition also tend to be older and “have greater baseline risk factors”. However, they note “whether significant discordance” in baseline risk and outcomes exists in younger patients under PCI “remains unclear”. Therefore, the aim of the present study was to review sex-related differences in patients aged 55 years or younger with acute coronary syndromes undergoing PCI.
Reviewing data from the PROMETHEUS study, a multicentre registry of patients undergoing PCI with one-year follow-up, Chandrasekhar et al identified 4,851 (of 19,914 overall) who were aged ≤55 years. Of these, 1,162 were women and 3,689 were men. The authors comment: “Women had higher body mass index and higher frequencies of several baseline risks—diabetes (41% vs. 27.9%, respectively), hypertension, active smoking, peripheral arterial disease, prior cerebrovascular disease (8.1% vs. 4.2%), and chronic kidney disease (12.7% vs. 7.2%).”
Furthermore, both the 90-day and the one-year rate of major adverse cardiac events (MACE) were significantly higher in women (9.5% vs. 7.3&; p=0.01 and 21.1 vs. 16.2%; p<0.001, respectively). The rates of myocardial infarction, unplanned revascularisation, and bleeding were also higher in women at both times points. The use of prasugrel (Efient, Daiichi Sankyo) was significantly lower in women. However, Chandrasekhar et al comment: “After multivariable adjustment, all risks were attenuated and no longer significant.”
The authors report: “As prevalence of cardiovascular disease increases in young individuals, greater attention is needed to lower baseline risks with focused strategies for secondary prevention, particularly young women.” They add that strategies have “consistently focused” on improving outcomes of acute myocardial infarction and “perhaps the risk and morbidity associated with less acute presentations has not been well understood and, therefore, ignored”. “Indeed, studies reporting greater coronary plaque and coronary calcium in men compared with women at any age may be misinterpreted as uniformly lower risk in women in regardless of systemic comorbidities,” Chandrasekhar et al state.
Senior author of the study, Roxana Mehran (The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA), told Cardiovascular News: “We must pay attention to our younger population, men or women, and in identifying disease early and making important life style changes as well as medical and revascularisation therapies as indicated. This is especially true for younger women; they are often ignored and not treated with guideline-based therapies.”
Usman Baber (Mount Sinai Hospital, New York, New York) presented the study at SCAI.