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. 2020 Jan 7;9(1):e014721.
doi: 10.1161/JAHA.119.014721. Epub 2019 Dec 19.

Temporal Trends Analysis of the Characteristics, Management, and Outcomes of Women With Acute Coronary Syndrome (ACS): ACS Israeli Survey Registry 2000-2016

Avital Porter  1   2 , Anika Paradkar  2 , Ilan Goldenberg  3   2   4 , Nir Shlomo  3   4 , Tal Cohen  3   4 , Ran Kornowski  1   2 , Alon Eisen  1   2
Affiliations

Temporal Trends Analysis of the Characteristics, Management, and Outcomes of Women With Acute Coronary Syndrome (ACS): ACS Israeli Survey Registry 2000-2016

Avital Porter et al. J Am Heart Assoc. .

Abstract

Background Cardiovascular disease remains a leading cause of death among women. Despite improvements in the management of patients with acute coronary syndrome (ACS), women with an ACS remain at higher risk. Methods and Results We performed a time-dependent analysis of the management and outcomes of women admitted with ACS who enrolled in the prospective biennial ACS Israeli Surveys between 2000 and 2016. Surveys were divided into 3 time periods (2000-2004, 2006-2010, and 2013-2016). Outcomes included 30-day major adverse cardiac events (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1-year mortality. Overall, 3518 women were admitted with an ACS. Their mean age (70±12 years) was similar among the time periods. Over the time course of the study, more women were admitted with non-ST-elevation ACS (51.9%, 59.6%, and 66.1%, respectively; P<0.001), and statins and percutaneous coronary intervention were increasingly utilized (66%, 91%, 93%, and 42%, 60%, and 68%, respectively; P<0.001 for each). Among women with ST-segment-elevation myocardial infarction, more primary percutaneous coronary interventions were performed (48.5%, 84.7%, and 95.3%, respectively; P<0.001). The rate of 30-day major adverse cardiac events has significantly decreased over the years (24.6%, 18.6%, and 13.5%, respectively; P<0.001). However, 1-year mortality rates declined only from 2000 to 2004 (16.9%, 12.8%, and 12.3%; P=0.007 for the overall difference), and this change was not significant after propensity matching or multivariate analysis. Conclusions Over more than a decade, 30-day major adverse cardiac events have decreased among women with ACS. Advances in pharmacological treatments and an early invasive approach may have accounted for this improvement. However, the lack of further reduction in 1-year mortality rates among women suggests that more measures should be provided in this high-risk population.

Keywords: acute coronary syndrome; sex; temporal trends.

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Figures

Figure 1
Figure 1
Type of acute coronary syndrome in women by survey year. ACSIS indicates Acute Coronary Syndrome Israeli Survey; NSTEMI, non–ST‐segment–elevation myocardial infarction; STEMI, ST‐segment–elevation myocardial infarction; UAP, unstable angina pectoris.
Figure 2
Figure 2
Kaplan‐Meier curves for 1‐year mortality according to the early (2000‐2004), middle (2006‐2010), and late (2013‐2016) time periods.
Figure 3
Figure 3
Kaplan‐Meier curve for 1‐year mortality after propensity matching: (A) early vs middle time period; (B) early vs late time period.
Figure 4
Figure 4
Multivariable analysis for 1‐year mortality. GRACE indicates Global Registry of Acute Coronary Events; HR, hazard ratio; PCI, percutaneous coronary intervention.
See this image and copyright information in PMC

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