Nia Emilova1, S. Denchev2, M. Gospodinova2, S. Dimitrov3, Т. Kundurdjiev4
1 Clinic of Cardiology, University Hospital „Аlexandrovska”, Sofia
2 Clinic of Cardiology, Medical Institute of the Ministry of Internal Affairs, Sofia
3 Department of Invasive Cardiology, MHAT „Hristo Botev”, Vratza
4 Faculty of Public Health, Medical University, Sofia
Purpose: We aimed to investigate the significance of gender-related contrasts concerning the risk profile, comorbidities and prognostic indicators of patients with acute coronary syndrome.
Material and methods: The study group included 259 patients (144 men, 55,6% and 115 women, 44,4%) with diаgnosed acute coronary syndrome (ACS), admitted to University Hospital „Alexandrovska”, Sofia. Data about risk factors for atherosclerosis, noncardiac chronic disease, type of presenting symptoms were collected through clinical exam. The echocardiographic indices of left ventricular systolic function (ejection fraction and end-systolic volume) were obtained with 2D - mode echocardiography. The coronary disease severity was assessed by calculating SYNTAX scores in those patients with performed selective coronary angiography. The frequency of adverse events for a period of one year was registered.
Results: Women were significantly older (69,5±10,9 vs 62±13,2 years, p<0,0001), had more frequently аrterial hypertension (96,5% vs 84%, p=0,001) and comorbidities (55% vs 33,3%, p=0,001). Smoking was more prevalent among male patients (66,2% vs 20,9%, p<0,0001). Atypical angina was encountered with similar frequency among female and male patients (22,2% vs 32,2%, p=0,089). The incidence of obstructive coronary disease (90,1% vs 76,6%, p=0,005) and acute myocardial infarction with persistent ST elevation were higher in the examined male group (65% vs 35%, p=0,008). In contrast to women, more subsequent percutaneous interventions (32,4% (n=35) vs 19,1% (n=17), p=0,037) and rehospitalisations (57% (n=61) vs 40% (n=36), p=0,022) were observed in the male group during follow-up.
Conclusion: Specific for male gender association with more extensive obstructive coronary atherosclerosis is observed in our study despite the lower coronary risk factor burden and fewer baseline comorbidities. The sex-based difference regarding risk for adverse cardiovascular outcome is dependent on the higher frequency of obstructive coronary atherosclerosis and left ventricular systolic dysfunction among male patients.
Кеy words: аcute coronary syndromes, prognostic indicators, sex