Sex differences in cardiovascular outcomes in patients with acute coronary syndrome undergoing percutaneous coronary...

Sex differences in acute coronary syndrome (ACS) presentation and outcomes have been increasingly recognized, yet data from Southeast Asian populations, particularly Thailand, remain limited. This study aimed to evaluate sex-specific differences in baseline characteristics, in-hospital mortality, and 1-year mortality among ACS patients undergoing percutaneous coronary intervention (PCI).

This retrospective cohort study included 1,579 patients aged ≥18 years diagnosed with ACS who underwent PCI at King Chulalongkorn Memorial Hospital between January 2017 and October 2021. Baseline characteristics, post-procedural complications, and outcomes were compared between sexes. Primary outcomes were in-hospital and 1-year mortality. Secondary outcomes included post-procedural complications such as coronary artery complications, vascular complications, acute kidney injury, stroke, bleeding, and nosocomial infections. One-year mortality was analyzed using Cox proportional hazards models and Kaplan-Meier survival analysis.

Among the study population, 453 (28.7%) were women. Women were significantly older (median: 70 vs. 60 years, P<0.001) and had higher rates of hypertension, diabetes, coronary artery disease, and atrial fibrillation. They were more likely to present with dyspnea (12.1% vs. 7.3%, P=0.006) and less likely to have ST-elevation myocardial infarction (STEMI) (50.8% vs. 62.8%, P<0.001). In-hospital mortality rates were higher in women but did not reach statistical significance (7.5% vs. 5.4%, P=0.12), while 1-year mortality was significantly higher in women (21.6% vs. 12.8%, P<0.001). After adjusting for confounders, the hazard ratio for 1-year mortality in women remained elevated [hazard ratio (HR): 1.46; 95% confidence interval (CI): 1.10-1.93; P=0.009]. Women also experienced higher rates of acute kidney injury, major bleeding, and nosocomial infections.

Women with ACS undergoing PCI presented with more comorbidities, atypical symptoms, and higher long-term mortality compared to men.