Sex differences in distribution, management and outcomes of combined ischemic-bleeding risk following acute coronary syndrome

Mohamed O. Mohamed, Muhammad Rashid, Adam Timmis, Sarah Clarke, Claire Lawson, Erin D. Michos, Chun Shing Kwok, Mark De Belder, Marco Valgimigli, Mamas A. Mamas

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Risk factors for further bleeding and ischemic events after acute coronary syndrome (ACS) often overlap. Little is known about sex-based differences in the management and outcomes of ACS patients according to their combined bleeding-ischemic risk. Methods: All ACS hospitalizations in the United Kingdom (2010–2017) were retrospectively analyzed, stratified by sex and bleeding-ischemic risk combination (using CRUSADE and GRACE scores). Multivariable logistic regression was performed to examine association between risk-groups and 1) receipt of guideline-recommended management and 2) in-hospital outcomes. Results: Of 584,360 patients, a third of males (32.3%) and females (32.6%) were in the dual high-risk group (High CRUSADE- High GRACE). In comparison to the dual low-risk group (Low CRUSADE-Low GRACE), the dual high-risk patients of both sexes were 59–83% less likely to receive inpatient revascularisation (PCI or CABG) and 50% less likely to receive dual antiplatelet therapy (DAPT) on discharge, with a significant increase in odds of MACE (~8 to 9-fold), all-cause and cardiac mortality (25 to 35-fold), and bleeding (78–91%). The greatest difference in management and clinical outcomes between sexes was found in the dual-high risk group where females were less likely to receive guideline-recommended therapy (revascularisation and DAPT), compared to males, and were more likely to experience MACE, all-cause and cardiac mortality. Conclusion: ACS patients with dual high-risk for bleeding and recurrent ischemia, especially females, are less likely to receive guideline-recommended therapy and experience significantly worse outcomes. Novel strategies are needed to effectively manage this highly prevalent, complex patient group and address the under-treatment of females.

Original languageEnglish (US)
Pages (from-to)16-22
Number of pages7
JournalInternational Journal of Cardiology
Volume329
DOIs
StatePublished - Apr 15 2021

Keywords

  • CRUSADE
  • GRACE
  • Management
  • Outcomes
  • Risk scores
  • Sex

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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