Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome
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Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome. / Sörensen, Nils Arne; Neumann, Johannes Tobias; Ojeda, Francisco; Schäfer, Sarina; Magnussen, Christina; Keller, Till; Lackner, Karl J; Zeller, Tanja; Karakas, Mahir; Münzel, Thomas; Blankenberg, Stefan; Westermann, Dirk; Schnabel, Renate B.
In: J AM HEART ASSOC, Vol. 7, No. 6, 10.03.2018.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome
AU - Sörensen, Nils Arne
AU - Neumann, Johannes Tobias
AU - Ojeda, Francisco
AU - Schäfer, Sarina
AU - Magnussen, Christina
AU - Keller, Till
AU - Lackner, Karl J
AU - Zeller, Tanja
AU - Karakas, Mahir
AU - Münzel, Thomas
AU - Blankenberg, Stefan
AU - Westermann, Dirk
AU - Schnabel, Renate B
N1 - © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2018/3/10
Y1 - 2018/3/10
N2 - BACKGROUND: The atypical presentation of women with acute coronary syndrome (ACS) has been related to delayed diagnosis and treatment, which may explain worse outcome compared with men.METHODS AND RESULTS: We analyzed pooled data of 2520 patients of 2 prospective cohorts in terms of differences in presentation and management of women and men suggestive of ACS. Using logistic regression, we established 2 diagnostic models and tested their diagnostic performance in both sexes separately. Sex-specific differences in management of patients with ACS were ascertained and a 2-year follow-up was performed. Women were older than men (median 67 versus 61 years, P=0.001), had more often dyspnea (22% versus 18%, P=0.024), nausea or vomiting (26% versus 16%, P=0.001) and radiating chest pain (47% versus 40%, P=0.001). Classical risk factors (smoking, diabetes mellitus, dyslipidemia or known coronary artery disease) were less frequent in women. Diagnostic models showed no significant sex-related differences in diagnostic performance in a "first contact" setting (medical history and symptoms) or after "complete triage" (including ECG and biomarkers). Women with ACS underwent coronary angiography (73.8% versus 84.3%, P<0.001) and revascularization (53.8% versus 70.1%, P<0.001) less frequently. Two-year incidence of myocardial infarction and death was similar in both sexes, but revascularization and cardiac rehospitalization were more frequent in men.CONCLUSIONS: In a large cohort of patients with suspected ACS, sex differences in clinical presentation did not impair diagnostic accuracy. Two-year outcomes were comparable. Our findings suggest a benefit of chest pain units to minimize sex differences in ACS management and prognosis.CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT02355457 (BACC), NCT03227159 (stenoCardia).
AB - BACKGROUND: The atypical presentation of women with acute coronary syndrome (ACS) has been related to delayed diagnosis and treatment, which may explain worse outcome compared with men.METHODS AND RESULTS: We analyzed pooled data of 2520 patients of 2 prospective cohorts in terms of differences in presentation and management of women and men suggestive of ACS. Using logistic regression, we established 2 diagnostic models and tested their diagnostic performance in both sexes separately. Sex-specific differences in management of patients with ACS were ascertained and a 2-year follow-up was performed. Women were older than men (median 67 versus 61 years, P=0.001), had more often dyspnea (22% versus 18%, P=0.024), nausea or vomiting (26% versus 16%, P=0.001) and radiating chest pain (47% versus 40%, P=0.001). Classical risk factors (smoking, diabetes mellitus, dyslipidemia or known coronary artery disease) were less frequent in women. Diagnostic models showed no significant sex-related differences in diagnostic performance in a "first contact" setting (medical history and symptoms) or after "complete triage" (including ECG and biomarkers). Women with ACS underwent coronary angiography (73.8% versus 84.3%, P<0.001) and revascularization (53.8% versus 70.1%, P<0.001) less frequently. Two-year incidence of myocardial infarction and death was similar in both sexes, but revascularization and cardiac rehospitalization were more frequent in men.CONCLUSIONS: In a large cohort of patients with suspected ACS, sex differences in clinical presentation did not impair diagnostic accuracy. Two-year outcomes were comparable. Our findings suggest a benefit of chest pain units to minimize sex differences in ACS management and prognosis.CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT02355457 (BACC), NCT03227159 (stenoCardia).
KW - Acute Coronary Syndrome/diagnosis
KW - Aged
KW - Female
KW - Germany/epidemiology
KW - Health Status Disparities
KW - Healthcare Disparities
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Predictive Value of Tests
KW - Reproducibility of Results
KW - Risk Assessment
KW - Risk Factors
KW - Sex Factors
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1161/JAHA.117.007297
DO - 10.1161/JAHA.117.007297
M3 - SCORING: Journal article
C2 - 29525782
VL - 7
JO - J AM HEART ASSOC
JF - J AM HEART ASSOC
SN - 2047-9980
IS - 6
ER -
