Influencia del género sobre el pronóstico del síndrome coronario agudo sin elevación del segmento ST y los resultados de la terapia intervencionista precoz

The influence of gender in the management and prognosis of non-ST segment elevation acute coronary syndrome (NSTE-ACS) is under debate. The aim of this study was to analyze the repercussion of gender in the prognosis of NSTE-ACS and the influence of an early interventional strategy on the results. The study included a historical cohort of 715 patients admitted consecutively with NSTE-ACS between January 2004 and December 2005, with a median follow-up of 24 months. Prognostic variables were studied, and an adjusted analysis made of the repercussions of gender and early intervention (< 72 h) on the variables. Of the 715 patients included, 31.9% were women. These women had an increased risk for the onset of heart failure, both during hospitalization (multivariate odds ratio [mOR] = 2.1; 95% CI 1.2-3.5; P = .004) and during the follow-up (mOR = 4.2; 95% CI 2.2-7.9; P = .001), with no differences regarding death, recurrent ischemia or arrhythmic events. Of the whole group of patients, 287 (28.2% women) received an early interventional strategy. This had a protective effect in the men, with a lower risk for the onset of heart failure either acutely (mOR = 0.46; 95% CI 0.22-0.95; P < .001) or during the follow-up (mOR = 0.19; 95% CI 0.55-0.70; P < .001). In conclusion, women admitted with NSTE-ACS had a worse prognosis both during the hospitalization phase and after long-term follow, with a greater risk for the onset of heart failure. The early interventional strategy only reduced the onset of heart failure in men.