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Eur Heart J. 2004 Apr;25(8):663-70.

Sex, age, and clinical presentation of acute coronary syndromes.

Author information

1
Department of Medicine, Goteborg University, Sahlgrenska University Hospital, Ostra, SE-416 85 Goteborg, Sweden. annika.rosengren@hjl.gu.se

Abstract

AIM:

To investigate sex differences in clinical presentation in younger and older patients hospitalised with a wide spectrum of acute coronary syndromes (ACS).

METHODS AND RESULTS:

We analysed 10253 patients with a discharge diagnosis of ACS in the Euro Heart Survey of patients with Acute Coronary Syndromes. There were 1010 women and 3709 men < 65 years. Among patients <65 years, fewer women than men presented with ST elevation, (OR [odds ratio]: 0.62 [0.53-0.71]) and developed Q-wave myocardial infarction (OR 0.58 [0.50-0.67]), whereas in patients > or =65 years there was no significant sex difference. Women <65 years were more likely than men of the same age to be discharged with a diagnosis of unstable angina (OR 1.56 [1.35-1.79]), but there was no sex difference in older patients; the p for interaction between sex and age for both was <0.0001. Among patients who underwent coronary angiography, both younger and older women were less likely than men to have 3-vessel or main stem disease. In a logistic regression analysis stratified for age, female sex was a significant negative determinant of presenting with ST elevation in patients <65 years (OR 0.68 [0.58-0.79]), whereas there was no effect of sex in patients > or =65 years.

CONCLUSION:

In younger patients with ACS, women were less likely than men to present with ST elevation and more likely to be discharged with a diagnosis of unstable angina. In older patients there were no differences in clinical presentation. Both older and younger women had less extensive atherosclerosis. The findings suggest a different pathophysiology of ACS in younger, but not older, women.

PMID:
15084371
DOI:
10.1016/j.ehj.2004.02.023
[Indexed for MEDLINE]

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