Gender differences and the outcome of interventions for acute coronary syndromes

Differences in the overall mortality for acute infarction in women vs men have been appreciated for some time. Some of these differences are based on the age at the time of presentation of women compared with men. Excess mortality in women is most clear at the younger end of the age spectrum. More careful examination of the data has shown differences based on factors such as greater delays in presentation in women, real biases in the types of healthcare provider, and selection of diagnostic and therapeutic interventions for women compared with men. Recently, the mode of presentation has emerged as a major defining point. Women present more frequently with unstable angina or non-Q-wave infarction and have lesser mortality with these syndromes compared with men. Thus, the overall outcomes of acute coronary syndromes vary substantially from the differences in outcome for acute Q-wave infarction alone. New data have emerged regarding differences in treatment outcome for acute infarction. Women have derived lesser benefit from thrombolytic therapy and still respond to percutaneous transluminal coronary angioplasty more favorably than thrombolytic therapy for acute infarction. Women seem to have less benefit from stent use compared with angioplasty alone for acute infarction. Although increasing scrutiny has shed a great deal of light on some of these gender differences in outcomes from acute coronary syndromes, a real difference in mortality for younger women remains unexplained. The basis for real differences in outcome with the use of various therapies for acute infarction, such as thrombolysis and stent use, are also not well elucidated.