Association of sex with outcome in elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention.

Abstract Background Worse outcomes have been reported for women, compared to 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 one-year outcome of elderly acute coronary syndrome patients treated by percutaneous coronary intervention (PCI). Methods Acute coronary syndrome patients aged ≥75 years successfully treated with PCI were selected among those enrolled in three Italian multicentre studies. Cox regression analysis was used to assess the independent predictive value of sex on outcome at 12-month follow-up. Results 2035 patients (44% women) were included. Women were older and most likely to present with 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=0.305) and cardiovascular mortality (5.7% vs. 4.1%, p=0.113). Higher cardiovascular mortality was observed in women after ST-elevation myocardial infarction (STEMI, 8.8% vs 5%, p=0.041), but not after non ST-Elevation-ACS (3.5% vs. 3.7%, p=0.999). 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=0.025). After adjustment for baseline clinical variables, female sex did not predict adverse outcome. Conclusions Elderly men and women with acute coronary syndrome show different clinical presentation and baseline risk profile. After successful PCI, unadjusted one-year cardiovascular mortality was significantly higher in women with STEMI and in those with first coronary event. However, female sex did not predict cardiovascular mortality after adjustment for the different baseline variables.