Sex and age differences and outcomes in acute coronary syndromes

Background: There is conflicting information about sex differences in presentation, treatment, and outcome after acute coronary syndromes (ACS) in the era of reperfusion therapy and percutaneous coronary intervention. The aim of this study was to examine presentation, acute therapy, and outcomes of men and women with ACS with special emphasis on their relationship with younger age ( lt = 65 years). Methods: From January 2010 to June 2015, we enrolled 5140 patients from 3 primary PCI capable hospitals. Patients were registered according to the International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC) registry protocol (ClinicalTrials.gov: NCT01218776). The primary outcome was the incidence of in-hospital mortality. Results: The study population was constituted by 2876 patients younger than 65 years and 2294 patients older. Women were older than men in both the young (56.2 +/- 6.6 vs. 54.1 +/- 7.4) and old (74.9 +/- 6.4 vs. 73.6 +/- 6.0) age groups. There were 3421 (66.2%) patients with ST elevation ACS (STE-ACS) and 1719 (33.8%) patients without ST elevation ACS (NSTE-ACS). In STE-ACS, the percentage of patients who failed to receive reperfusion was higher in women than in men either in the young (21.7% vs. 15.8%) than in the elderly (35.2% vs. 29.6%). There was a significant higher mortality in women in the younger age group (age-adjusted OR 1.52, 95% CI: 1.01-2.29), but there was no sex difference in the older group (age-adjusted OR 1.10, 95% CI: 0.87-1.41). Significantly sex differences in mortality were not seen in NSTE-ACS patients. Conclusions: In-hospital mortality from ACS is not different between older men and women. A higher short-term mortality can be seen only in women with STEMI and age of 65 or less

Time From First Medical Contact to Aspirin in ST Elevation Myocardial Infarction: An International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) Study

BACKGROUND: A significant number of patients who suffer from STEMI do not reach a hospital within the recommended timeframe in the South Eastern European countries. Unequal dispersion of PCI-capable facilities throughout this area results in transport distances that can exceed 100 miles, while response times vary greatly dependent upon volunteer ambulance services. METHODS: The aim of the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC /NCT01218776 ) registry was to assess whether initial antiplatelet/ anticoagulant treatment at the point of prehospital first medical contact impacts in-hospital outcomes. To assess the value of this strategy were compared: prehospital versus in-hospital first medical contact; those arriving at the hospital by ambulance versus those whose initial hospital care was an ambulatory/community center. RESULTS: Of the 2295 patients enrolled in the study, 392 received fibrinolysis, 753 primary PCI, 86 facilitated PCI, and 1064 standard medical therapy having overcome the golden hours for reperfusion therapy. Compared with the in-hospital group, patients who underwent facilitated PCI (7%, n=34) experienced 9.6 % reduction in cardiovascular mortality (odd ratio [OR] 0.096 coefficient interval [C.I] 0.012-0.69 P=0.004). Arrival by an ambulatory/community center incurred a substantial delay from first medical contact to reperfusion (fibrinolysis 76 min [63 min to 105 min] and PCI 35 min [224 min to 612 min]) compared with arrival by ambulance (fibrinolysis 47 min [32 min to 68 min] and PCI 108 min [85 min to 150 min]). CONCLUSIONS: These findings support prehospital antiplatelet/ anticoagulant treatment followed by reperfusion therapy in patients presenting early with STEMI, who do not have access to hospital care within the recommended time-frame of 60 minutes from first medical contact. Those activating the prehospital medical response system without receiving prehospital ambulance assignment experienced the longest delay from first medical contact to reperfusion, indicating a lost opportunity to enhance ST elevation myocardial infarction patient outcomes