Influencia del sexo en la mortalidad y el manejo del síndrome coronario agudo en España

Coronary heart disease is a major health problem in women. In Spain, it is the cause of death in 10%. The aim of this study was to investigate possible sex differences in the clinical characteristics, cardiovascular risk profile, diagnostic assessment, treatment and prognosis of patients admitted with acute coronary syndrome (ACS) in Spain between 1994-2002. Data from trials conducted by the Working Group on Ischemic Heart Disease and Coronary Care Units of the Spanish Society of Cardiology Section during this period (i.e., RISCI, PRIAMHO I and II, DESCARTES and TRIANA) were analyzed. Data were reclassified and combined into a single database that included 48,369 patients (75.7% male and 24.3% female). Of these, 13,405 (26.6% female) had non-STelevation acute coronary syndrome (NSTEACS), while 34,334 (23.2% female) had ST-elevation acute coronary syndrome (STEACS). Compared with men, women were older, had a worse cardiovascular risk profile, more often had a history of heart failure, received beta-blockers and tatins less often, were less likely to undergo percutaneous revascularization, presented on admission with a 50% higher mortality rate and incidence of serious adverse events, and had higher mortality during followup. The sex differences in those with STEACS were similar: fewer women underwent coronary reperfusion and the time to reperfusion was significantly longer. In addition, the initial mortality, in-hospital complication and 1-month mortality rates in women were double those in men. However, female gender was an independent predictor of in-hospital, 1-month and 1-year mortality only for STEACS, and not for NSTEACS. In conclusion, sex differences were found in the clinical profile and management of patients admitted for ACS. However, sex was an independent predictor of mortality only in those with STEACS.