30-day mortality similar between men, women after adjusting for clinical characteristics

Issue: October 2009

Sex-based differences in 30-day mortality in patients with acute coronary syndromes varied according to differences in clinical presentation.

Researchers assembled a convenience sample of 136,247 patients with ACS pooled from 11 randomized, international trials. Among those, 38,048 (28%) were women. The sample included 102,004 patients with STEMI, 14,466 patients with non-STEMI and 19,777 patients with unstable angina. The primary study endpoint was all-cause mortality within 30 days of enrollment.

According to the study results, women had significantly higher unadjusted 30-day mortality vs. men (OR=1.91; 95% CI, 1.83-2.00), but the difference was not significant after adjusting for clinical characteristics (OR=1.06; 95% CI, 0.99-1.15). In patients with STEMI, unadjusted 30-day mortality was significantly higher among women than men (OR=2.29; 95% CI, 2.18-2.40), but the significance was attenuated when clinical characteristics were adjusted (OR=1.15; 95% CI, 1.06-1.24).

Unadjusted 30-day mortality for patients with non-STEMI was higher in women (OR=1.50; 95% CI, 1.28-1.75), but after adjusting for clinical characteristics, it was lower in women than in men (OR=0.77; 95% CI, 0.63-0.95). In patients with unstable angina, the 30-day mortality was similar between women and men (OR=0.86; 95% CI, 0.72-1.03) and was lower in women after adjustment for clinical characteristics (OR=0.55; 95% CI, 0.43-0.70). There was no interaction between sex and the severity of disease on 30-day mortality (P=.70), but there was an interaction between sex and type of ACS (P<.001).

“This study further highlights the clinical and angiographic differences among men and women at presentation with ACS. Understanding and considering these differences may lead to better risk stratification and treatment of all patients with ACS,” the researchers wrote.

Berger JS. JAMA. 2009;309:874-882.