Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome

Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, p < 0.001) and more often had a history of hypertension (77% vs. 83.1%, p < 0.01). Anemia and chronic kidney disease were both more common in women. On the other hand, they less frequently had a prior history of arteriosclerotic cardiovascular disease or comorbidities such as peripheral artery disease and chronic pulmonary disease. Women showed a worse clinical profile on admission, though an invasive approach and in-hospital revascularization were both more often performed in men (p < 0.001). At a one-year follow-up, 1090 patients (15%) had died, without a difference between sexes. Male sex was an independent predictor of mortality (HR = 1.15, 95% CI 1.01 to 1.32, p = 0.035), and there was a significant interaction between sex and DM (p = 0.002). DM was strongly associated with mortality in women (HR: 1.45, 95% CI = 1.18–1.78; p < 0.001), but not in men (HR: 0.98, 95% CI = 0.84–1.14; p = 0.787). In conclusion, DM is associated with mortality in older women with NSTEACS, but not in men.

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Prognostic significance of presenting blood pressure in non–ST-segment elevation acute coronary syndrome in relation to prior history of hypertension

American Heart Journal ◽

10.1016/j.ahj.2013.06.025 ◽

2013 ◽

Vol 166 (4) ◽

pp. 716-722 ◽

Cited By ~ 16

Author(s):

Dana Lee ◽

Shaun G. Goodman ◽

Keith A.A. Fox ◽

J. Paul DeYoung ◽

Christopher C. Lai ◽

...

Keyword(s):

Blood Pressure ◽

Acute Coronary Syndrome ◽

Prognostic Significance ◽

Prior History ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

History Of ◽

Elevation Acute Coronary Syndrome

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Octogenarian women with acute coronary syndrome present frailty and readmissions more frequently than men

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872618798226 ◽

2018 ◽

Vol 8 (3) ◽

pp. 252-263 ◽

Cited By ~ 8

Author(s):

Lourdes Vicent ◽

Albert Ariza-Solé ◽

Oriol Alegre ◽

Juan Sanchís ◽

Ramón López-Palop ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Poor Prognosis ◽

Prior History ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Female Sex ◽

St Segment ◽

History Of ◽

Elevation Acute Coronary Syndrome ◽

Artery Disease

Background: A worse prognosis has been reported among women with acute coronary syndrome compared to men. Our aim was to address the role of frailty and sex in the management and prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome. Methods: A prospective registry in 44 Spanish hospitals including patients aged 80 years and older with non-ST-segment elevation acute coronary syndrome. Frailty assessment was performed using the FRAIL scale. Results: Of a total of 535 patients, 207 (38.7%) were women. Mean age was 84.8±4.0 years, similar in men and women. A prior history of coronary artery disease was more common in men (146, 44.9%) than in women (46, 22.2%), P<0.001. Frailty was less frequent in men (65, 20.2%) than in women (77, 37.8%), P<0.001. Female sex was an independent predictor of death/hospitalisation (hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.1–2.4) and of hospitalisation at 6 months (HR 1.6, 95% CI 1.04–2.4). In men, compared to non-frail patients, both a prefrail status (HR 3.47, 95% CI 1.22–9.89) and frailty (HR 3.19, 95% CI 1.08–9.43) were independently associated with higher mortality. In women only frailty was independently associated with higher mortality (HR 5.68, 95% CI 1.91–16.18, compared to prefrailty or robustness). Frailty was associated with readmissions in men (HR 3.34, 95% CI 1.79–6.22) but not in women. Conclusions: In octogenarians with acute coronary syndrome female sex was independently associated with death/hospitalisation at 6 months. Frailty was more common in women and was a predictor of poor prognosis. In men prefrailty also predicted a poor prognosis.

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Statin Treatment and Prognosis of Elderly Patients Discharged after Non-ST Segment Elevation Acute Coronary Syndrome

Cardiology ◽

10.1159/000500824 ◽

2019 ◽

Vol 143 (1-2) ◽

pp. 14-21 ◽

Cited By ~ 2

Author(s):

Lourdes Vicent ◽

Albert Ariza-Solé ◽

Pablo Díez-Villanueva ◽

Oriol Alegre ◽

Juan Sanchís ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Elderly Patients ◽

Ldl Cholesterol ◽

Statin Treatment ◽

Invasive Approach ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Cholesterol Levels ◽

St Segment ◽

Elevation Acute Coronary Syndrome

Background: Statins are recommended for secondary prevention. Our aims were to describe the proportion of very elderly patients receiving statins after non-ST segment elevation acute coronary syndrome (NST-ACS) and to determine the prognostic implications of statins use. Methods: This prospective registry was performed in 44 hospitals that included patients ≥80 years discharged after a NST-ACS from April 2016 to September 2016. Results: We included 523 patients, the mean age was 84.2 ± 4.0 years and 200 patients (38.2%) were women. Previous statin treatment was recorded in 282 patients (53.4%), and 135 (32.5%) had LDL cholesterol levels >2.6 mmol/L. Mean LDL cholesterol levels during admission were 2.3 ± 0.9 mmol/L. Statins were prescribed at discharge to 474 patients (90.6%). Compared with patients discharged on statins, those that did not receive statins were more often frail (22 [47.8%] vs. 114 [24.4%], p < 0.01) and underwent an invasive approach less frequently (30 [61.2%] vs. 374 [78.9%], p = 0.01). During a 6-month follow-up, 50 patients died (9.5%). There was a nonsignificant trend to higher mortality in patients not treated with statins (6 [15%] vs. 44 [9.6%], p = 0.30), but statins were not independently associated with lower mortality (hazard ratio [HR] 0.79; 95% confidence interval [CI] 0.30–2.11, p = 0.65), nor with a reduction in the combined endpoint mortality/hospitalizations (HR 0.89; 95% CI 0.52–1.55, p = 0.69). Conclusions: Although most octogenarians presenting a NST-ACS are already on statins before the episode, their LDL cholesterol is frequently >2.6 mmol/L. Octogenarians who do not receive statins have a high-risk profile, with significant frailty and comorbidity.

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