Young women with premature acute coronary syndrome now do as well as men


It has become commonly accepted that women do worse than men following a heart attack or other coronary event. Earlier studies have documented that young women are more likely to die from cardiac-related events compared to men in the twelve months after hospital discharge. A new study published in the Canadian Journal of Cardiology, drawing on contemporary data from 26 hospitals, reports that young patients with acute coronary syndrome have good one-year prognosis, with men and women doing equally well.

The occurrence of coronary heart disease in the general population has steadily declined over the past few decades, however, premature acute coronary syndrome remains a significant cause of morbidity and mortality worldwide. The rate of decline in deaths from acute coronary syndrome among young to middle-aged adults has slowed, possibly due to increasing prevalence of abdominal obesity, diabetes, and hypertension in this population. In young women mortality has even increased.

“Despite such trends in younger adults, outcomes data in this population are still scarce,” explains lead investigator Louise Pilote, director of the Division of General Internal Medicine at McGill University, Montreal, Quebec, Canada. “Furthermore, sex differences in adverse clinical outcomes of these patients remain understudied. We therefore aimed to measure the incidence of adverse clinical outcomes, as well as rates and reasons for rehospitalisations over the twelve months following hospitalisation for an adverse coronary event, in patients aged 55 years or less.”

Investigators used data from GENESIS-PRAXY (Gender and Sex Determinants of Cardiovascular Disease from Bench to Beyond in Premature Acute Coronary Syndrome), a multicentre, prospective cohort study of patients hospitalized for acute coronary syndrome.

The wider aim of GENESIS-PRAXY is to document potential differences between men and women in presentation, access to care, and outcomes after the premature occurrence of acute coronary syndrome, and to investigate the potential biological, clinical, psychosocial, and environmental determinants of these differences.

Eligible patients were adults aged between 18 and 55 who were admitted to hospital with a confirmed diagnosis of acute coronary syndrome. Between January 2009 and April 2013, over 1,200 patients were enrolled in centres in Canada, the USA and Switzerland.

Specifically, investigators documented two types of adverse clinical outcomes: major adverse cardiovascular events, defined as any occurrence of recurrent acute coronary syndrome, a need for percutaneous coronary intervention, coronary artery bypass grafting surgery, or cardiac-related mortality; and death (all-cause and cardiac-related).

In contrast to earlier studies, these investigators observed similar rates of major adverse cardiac events, deaths, and cardiac-related re-hospitalisations between men and women in the year following hospitalisation for premature acute coronary syndrome. In both men and women, the majority of re-hospitalisations were cardiac-related, with chest pain or angina the most common reasons for re-hospitalisation.

Women were overall more likely than men to be re-hospitalised for all causes after premature acute coronary syndrome, regardless of type, but this difference was not present when looking at cardiac-related re-hospitalisation specifically. Men and women faced a high, yet similar, likelihood of major adverse cardiovascular health within the twelve months following the initial event. Women did not have an increased risk of mortality compared to men, and the overall mortality rate was low. The survival rate at one year was 99%.

“Although women were more likely to be re-hospitalised, they had similar outcomes to men,” comments Pilote. “It has been shown that women are more concerned and aware of their health than men, so it is possible that women have a greater rate of rehospitalisation because they are more inclined to consult, and likely to be admitted following emergency room visits, given their recent acute coronary syndrome history.

“The 99% survival rate at one year is encouraging, and is lower than mortality rates observed in prior studies of older and comparable age patients, which may indicate that practices in younger acute coronary syndrome adults have improved,” she concludes.

“In 2012, almost 1,900 Canadians under the age of 55 died from ischaemic heart disease, which accounts for 9% of all deaths under 55 years in Canada annually. Premature acute coronary syndrome is also a significant cause of lost work productivity, unemployment, and disability in this young age category,” notes Tara L Sedlak, and Mona Izadnegahdar, of Vancouver General Hospital, Vancouver, Canada, in an accompanying editorial. “This comprehensive and well-written study is encouraging for the future and provides valuable and much needed insight into understanding and improving the prognosis of younger acute coronary syndrome patients. The results of this long-term study, among an acute coronary syndrome population, are reassuring in that no important differences were seen in mortality or major adverse cardiovascular events between men and women during the first twelve months.”