Sex Differences in Risk for Developing Major Adverse Cardiovascular Events One Year after Hospital Discharge in Patients with Acute Coronary Syndrome

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Chutiporn Dansuwan
Chennet Phonphet
Jom Suwanno Suwanno

Abstract

This study aimed to compare the differences in risks for developing MACE one year after hospital discharge between female and male patients with Acute Coronary Syndrome (ACS). Data for this secondary data analysis were obtained from 187 patients in a secondary hospital. MACE was measured by the GRACE risk score. Chi-square tests, Fisher’s exact tests and binary logistic regression were used to examine associations between the variables. The results showed that women had a higher average GRACE risk score and high-risk level than males (p-value = 0.001, 0.004, respectively). Moreover, the significant factors associated with one year mortality included age (≥80 years old) (Adjusted OR = 5.38, 95%CI: 1.40-20.69) and elevated cardiac enzymes (Adjusted OR = 5.04, 95%CI: 1.03-24.47). When classified by sex, the significant association between age and one year mortality was found only in males (Adjusted OR = 8.56, 95%CI: 1.57-46.56). The results of this study indicated that age play a crucial factor in developing MACE in patients with ACS. Healthcare providers should focus on providing care to patients with ACS aged ≥80 years, with elevated cardiac enzymes and/or a history of heart failure.

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1.
Dansuwan C, Phonphet C, Suwanno JS. Sex Differences in Risk for Developing Major Adverse Cardiovascular Events One Year after Hospital Discharge in Patients with Acute Coronary Syndrome. Health Sci J Thai [Internet]. 2022 Jul. 29 [cited 2024 Apr. 23];4(3):83-9. Available from: https://he02.tci-thaijo.org/index.php/HSJT/article/view/256443
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References

Kip KE, Hollabaugh K, Marroquin OC, Williams D O. The problem with composite end points in cardiovascular studies the story of major adverse cardiac events and percutaneous coronary intervention. JACC 2008; 51(7): 701-707.

Abe D, Sato A, Hoshi T, Muruta S, Misaki M, Kakefuda Y, et al. Drug-eluting versus bare-metal stent in large coronary arteries of patients with ST-segment elevation myocardial infarction: Findings from the ICAS registry. Journal of Cardiology 2014; 64: 377-383.

Reinstadler S, Stietmaier T, Eitel C, Saad M, Metzler B, Waha S, et al. Antecedent hypertension and myocardial injury in patients with reperfused ST-elevation myocardial infarction. Journal of Cardiovascular Magnetic Resonance 2016; 18 (1): 1-8.

Lee WC, Fang HY, Chen HC, Chen CJ, Yang HY, Hang CL, et al. Anemia: A significant cardiovascular mortality risk after ST-segment elevation myocardial infarction complicated by the comorbidities of hypertension and kidney disease. PLOS ONE 2017; 12(7): 1-13.

Sukkong P, Phonpet C, Suwanno J, Wordet S, Chaimay B. Predictors of mortality at one-year after hospital discharge among patients with acute coronary syndrome. Thai Journal of Cardio-Thoracic Nursing. 2021; 32(1): 44-58.

Sarma AA, Braunwald E, Cannon CP, Guo JK, Antman EM, Gibson CM, et al. Outcomes of women compared with men after non-ST-segment elevation acute coronary syndromes. JACC 2019; 74(24): 3013-3022.

Pocock S, Bueno H, Licour M, Medina J, Zhang L, Annemans L, et al. Predictors of one-year mortality at hospital discharge after acute coronary syndromes: A new risk score from the EPICOR (long-term follow up of antithrombotic management patterns in acute coronary syndrome patients) study. Eur. Heart J. 2015; 4(6): 509-517.

Yu J, Oh PC, Kim M, Moon J, Park YM, Lee K, et al. Improved early risk stratification of patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention using a combination of serum soluble ST2 and NT-proBNP. PloS ONE 2017; 12(8): 1-12.

Gershlick A H, Banning AS, Parker E, Wang D, Budgeon CA, Kelly DJ, et al. Long-term follow up of complete versus lesion-only revascularization in STEMI and multivessel disease the CvLPRIT trail. JACC 2019; 74(25): 3083-3094.

Udell JA, Koh M, Qiu F, Austin PC, Wijeysundera HC, Bagai A, Yan AT, Goodman SG, Tu JV, Ko DT. Outcomes of women and men with acute coronary syndrome treated with and without percutaneous coronary revascularization. American Heart Association Journal. 2017; 6: 1-10.

Carlo MD, Morici N, Savonitto S, Grassia V, Sbarzaglia P, Tamburrini P, Cavallini C, Galvani M, Ortolani P, Sevi SD, Petronio AS. Sex-related outcomes in elderly patients presenting with non-ST-Segment elevation acute coronary syndrome insights from the Italian Elderly ACS Study. JACC: Cardiovascular Interventions. 2015; 8(6): 791-796.

Suwanno J, Chauychu B, Phonphet C. Association of risk level and major adverse cardiovascular events in patients with non-ST elevation myocardial infarction: A clinical assessment using GRACE risk score. Thai Journal of Cardio-Thoracic Nursing 2018; 29 (1): 17-28.

Carter LW, McEvedy S, Wilson A, Rahman MA. Gender differences in presentation, coronary intervention, and outcomes of 28,985 acute coronary syndrome patients in Victoria, Australia. Woman’s Health Issues. 2016; 26(1): 14-20.1-10

Haider A, Bengs S, Luu J, Osto E, Matula JS, Muka T, Gebhard C. Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome. Euro Heart J. 2020; 41: 1328-1336.

Vaccarino V, Parsons L, Every NR, Barron HV, Krumholz SM. Sex-based differences in early mortality after myocardial infarction, N Engl J Med. 1999; 341 (4): 217-225.

Eagle KA, Lim MJ, Dabbous OH, Pieper KS, Goldberg RJ, Werf FV, Goodman SG, Granger CB, Steg PG, Gore JM, Budaj A, Avezum A, Flather MD, Fox KA. A validated prediction model for all forms of acute coronary syndrome estimating the risk of 6-month post discharge death in an international registry. JAMA. 2004; 291(22): 2727-2733.

Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Werf FV, Avezum A, Goodman SG, Flather MD, Anderson FA, Granger CB. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: Prospective multinational observational study (GRACE). BMJ. 2016; 333: 1091-1094.

Tang EW, Wong CK., Herbinson P. Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome. Am Heart J 2007; 153: 29-35.

Komiyama K, Nakamura M, Tanabe K, Niikura H, Fujimoto H, Oikawa K, et al. In-hospital mortality analysis of Japanese patients with acute coronary syndrome using the Tokyo CCU Network database: Applicability of the GRACE risk score. Journal of Cardiology 2018; 71: 251-258.

Hao Y, Liu J, Lui J, Yang N, Smith S, Huo Y, Fonarow GC, Ge J, Taubert KA, Morgan L, Zhou M, Xing Y, Ma CS, Han Y, Zhao D. Sex differences in in-hospital management and outcomes of patients with acute coronary syndrome finding from the CCC project. Circulation. 2019; 139: 1776-1785.

Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, et al. Predictors of hospital mortality in the global registry of acute coronary events. Archives of Internal Medicine 2003; 163: 2345-2355.

Stebbins A, Mehta RH, Armstrong PW, Lee KL, Hamm C, Werf VD, James S, Nielsen TT, Gomes RS, White HD, Granger CB. A model for predicting mortality in acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention result from the assessment of pexelizumab in acute myocardial infarction trail. Circulation Cardiovascular Intervention. 2010; 3: 414-422.

Mohanan PP, Mathew R, Harikrishnan S, Krishnan MN, Zachariah G, Joseph J, Epen K, Abraham M, Menon J, Thomas M, Jacob S, Huffman MD, Prabhakaran D. Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala. Euro Heart J. 2012; 34: 121-129.

Gale CP, Manda SOM, Weston CF, Birkhead JS, Batin PD, Hall AS. Evaluation of risk scores for risk stratification of acute coronary syndromes in the Myocardial Infarction National Audit Project (MINAP) database. Heart 2008; 95: 221-227.

Lam L, Ahn HJ, Okajima K, Schoenman K, Seto TB, Shohet RV, Miyamura J, Sentell TL, Nakagawa K. Gender differences in the rate of 30-day readmissions after percutaneous coronary intervention for acute coronary syndrome. Women’s Health Issues 2019; 29(1): 17-22.

Oliveira LMS, Costa IM, Silva DG, Silva JR, Filho JA, Santos MA, Oliveira JLM, Buarque MD, Vieira DA, Sousa AC. Readmission of patients with acute coronary syndrome and determinants. Arquivos Brasileiros de Cardiologia 2019; 113(1): 42-49.

Gupta T, Kolte D, Khera S, Agarwal N, Villablanca PA, Goel K. Contemporary Sex-based differences by age in presenting characteristics, use of an early invasive strategy, and inhospital mortality in patients with non-ST-segment-elevation myocardial infarction in the United States. Circulation Cardiovascular Interventions 2018; 11: 1776-1785.

Lu HT, Nordin R, Ahmad WZ, Lee CY, Zambahari R, Ismail O, et al. Sex differences in acute coronary syndrome in a multiethnic Asian population results of the Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) Registry. Global Heart 2014; 9(4): 381-390.

Menyar AE, Ahmed E, Albinali H, Thani HA, Gehani A, Singh R, et al. Mortality trends in women and men presenting with acute coronary syndrome: Insights from a 20-Year Registry. PLOS ONE 2013; 8 (7): 1-10.

Stebbins A, Mehta RH, Armstrong PW, Lee KL, Hamm C, Werf VD, et al. A model for predicting mortality in acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention result from the assessment of pexelizumab in acute myocardial infarction trail. Circulation Cardiovascular Intervention 2010; 3: 414-422.

Lu HT, Nordin R, Ahmad WZ, Lee CY, Zambahari R, Ismail O, et al. Sex differences in acute coronary syndrome in a multiethnic Asian population results of the Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) Registry. Global Heart 2014; 9(4): 381-390.

Kimenai, DM, Shah AS, McallisterDA, Lee KK, Tsanas A, Meex S J, et al. Sex differences in cardiac troponin I and T and the prediction of cardiovascular events in the general population. Clinical Chemistry 2021; 67(10):1351-1360.

Steg PG, Dabbous OH, Feldman LJ, Solal AC, Aumont MC, Sendon JL, et al. Determinants and prognostic impact of heart failure complicating acute coronary syndromes observations from the Global Registry of Acute Coronary Event (GRACE). Circulation 2014; 109: 494-499.

Stebbins A, Mehta RH, Armstrong PW, Lee KL, Hamm C, Werf VD, et al. A model for predicting mortality in acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention result from the assessment of pexelizumab in acute myocardial infarction trail. Circulation Cardiovascular Intervention 2010; 3: 414-422.

Shah RU, Tsai V, Klein L, Heidenreich PA. Characteristics and outcomes of very elderly patients after first hospitalization for heart failure. Circulation Heart Failure 2011, 4, 301-307.