• Roberta De Rosa, Nuccia Morici, Giuseppe De Luca, Leonardo De Luca, Luca A Ferri, Luigi Piatti, Giovanni Tortorella, Daniele Grosseto, Nicoletta Franco, Leonardo Misuraca, Paolo Sganzerla, Michele Cacucci, Roberto Antonicelli, Claudio Cavallini, Laura Lenatti, Chiara Leuzzi, Ernesto Murena, Amelia Ravera, Maurizio Ferrario, Elena Corrada, Delia Colombo, Francesco Prati, Federico Piscione, A Sonia Petronio, Gennaro Galasso, Stefano De Servi, Stefano Savonitto, and Italian Elderly ACS Collaboration.
• University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy; Goethe University Hospital Frankfurt, Frankfurt am Main, Germany.
• Am. J. Med. 2021 Sep 1; 134 (9): 1135-1141.e1.

BackgroundWorse outcomes have been reported for women, compared with men, after an acute coronary syndrome (ACS). Whether this difference persists in elderly patients undergoing similar invasive treatment has not been studied. We investigated sex-related differences in 1-year outcome of elderly acute coronary syndrome patients treated by percutaneous coronary intervention (PCI).MethodsPatients 75 years and older successfully treated with PCI were selected among those enrolled in 3 Italian multicenter studies. Cox regression analysis was used to assess the independent predictive value of sex on outcome at 12-month follow-up.ResultsA total of 2035 patients (44% women) were included. Women were older and most likely to present with ST-elevation myocardial infarction (STEMI), diabetes, hypertension, and renal dysfunction; men were more frequently overweight, with multivessel coronary disease, prior myocardial infarction, and revascularizations. Overall, no sex disparity was found about all-cause (8.3% vs 7%, P = .305) and cardiovascular mortality (5.7% vs 4.1%, P = .113). Higher cardiovascular mortality was observed in women after STEMI (8.8%) vs 5%, P = .041), but not after non ST-elevation-ACS (3.5% vs 3.7%, P = .999). A sensitivity analysis excluding patients with prior coronary events (N = 1324, 48% women) showed a significantly higher cardiovascular death in women (5.4% vs 2.9%, P = .025). After adjustment for baseline clinical variables, female sex did not predict adverse outcome.ConclusionsElderly men and women with ACS show different clinical presentation and baseline risk profile. After successful PCI, unadjusted 1-year cardiovascular mortality was significantly higher in women with STEMI and in those with a first coronary event. However, female sex did not predict cardiovascular mortality after adjustment for the different baseline variables.Copyright © 2021 Elsevier Inc. All rights reserved.

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