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Management and Outcomes of Elderly Women and Men With Acute Coronary Syndromes in 2000 and 2002
Mady Moriel, MD;
Shlomo Behar, MD;
Dan Tzivoni, MD;
Hanoch Hod, MD;
Valentina Boyko, MSc;
Shmuel Gottlieb, MD
Arch Intern Med. 2005;165:1521-1526.
Background Previous studies have suggested that women with myocardial infarction are treated less aggressively and have worse outcomes compared with men. The objective of this study was to evaluate sex differences in the management and outcomes of elderly (age  70 years) women and men with acute coronary syndromes (ACSs) in the new millennium.
Methods This study includes 1331 consecutive elderly patients with ACSs admitted to all intensive coronary care units and cardiology departments in Israel from 2 prospective nationwide ACS surveys conducted in 2000 and 2002.
Results The mean age of women vs men was comparable (79 vs 78 years). Comorbidities were more frequent in women, whereas previous coronary disease and typical anginal pain on admission were more frequent in men. Medical treatments and revascularization procedures during the index hospitalization were comparable in both groups. Crude and covariate-adjusted mortality rates were higher in women at 7 days (12% vs 7%; P = .007; adjusted odds ratio [OR], 1.83; 95% confidence interval [CI], 1.15-2.91) but not at 6 months (21% vs 19%; adjusted OR, 1.10; 95% CI, 0.79-1.52). This difference was attributed to ST elevation (STE)–ACS in women vs men (19% vs 12%; P = .007; adjusted OR, 1.97; 95% CI, 1.14-3.46). Seven-day mortality rates were highest in patients with STE-ACS denied coronary angiography, especially women (23% vs 15%; P = .06).
Conclusions In the 2000s, elderly women and men with ACSs are receiving similar medical and invasive management during the index hospitalization; however, women with STE-ACS have higher mortality rates at 7 days but not at 6 months. Mortality rates are highest in patients with STE-ACS denied coronary angiography. The benefit of invasive procedures on mortality rates in elderly patients with STE-ACS needs further investigation.
Author Affiliations: Department of Cardiology, Shaare Zedek Medical Center, Jerusalem (Drs Moriel and Tzivoni); Neufeld Cardiac Research Institute, Sheba Medical Center, Tel HaShomer (Drs Behar, Hod, and Gottlieb and Ms Boyko); and Heiden Department of Cardiology, Bikur Holim Hospital, Jerusalem (Dr Gottlieb), Israel.
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