Advertisement

Clinical Research in Cardiology

, Volume 104, Issue 8, pp 648–655 | Cite as

Acute coronary syndrome in young women under 55 years of age: clinical characteristics, treatment, and outcomes

  • Melinda Davis
  • Jamie Diamond
  • Daniel Montgomery
  • Sangeetha Krishnan
  • Kim Eagle
  • Elizabeth Jackson
Original Paper

Abstract

Background

Young women with acute coronary syndrome (ACS) may represent a high risk group, but little is known about specific age and sex differences in clinical characteristics, treatment, outcomes, and trends over time.

Methods

Data from 3237 men and women admitted with an ACS event from 1999 to 2006 were analyzed. Patients were grouped by sex and age less than 55 years. Demographics, presentation, treatment, and outcomes at 6 months were analyzed. Primary outcomes included mortality, recurrent myocardial infarction, rehospitalization, and stroke at 6 months. Secondary analyses assessed risk factors, management, and trends over time.

Results

Women under 55 years represented 8 % of the entire cohort, and 26 % of patients under age 55 years. Compared to older women, young women were more likely to be smokers (51 vs. 14 %, p < 0.001) and obese (44 vs. 34 %, p = 0.006). Young women had more diabetes and hypertension than young men. Mortality was lowest among young women and did not change over time. Young women received less treatment with aspirin, beta blockers, lipid-lowering agents, and ACE inhibitors, and underwent less coronary angiography and stenting than young men (44 vs. 59 %, p < 0.001). Rehospitalization was higher among young women than young men (37 vs. 27 %, p < 0.001), with no change over time.

Conclusions

Modifiable risk factors such as smoking, obesity, diabetes, and hypertension should be addressed in young women. Following ACS, young women received fewer evidence-based medications, were treated less invasively, and had higher readmission rates within 6 months compared to young men.

Keywords

Gender ACS Outcomes Young women Disparities 

Notes

Conflict of interest

The authors declare that they have no conflict of interest. This study was approved by the Institutional Review Board and conducted in accordance with the ethical standards in the 1964 Declaration of Helsinki.

References

  1. 1.
    Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, Newby LK, Pina IL, Roger VL, Shaw LJ, Zhao D, Beckie TM, Bushnell C, D’Armiento J, Kris-Etherton PM, Fang J, Ganiats TG, Gomes AS, Gracia CR, Haan CK, Jackson EA, Judelson DR, Kelepouris E, Lavie CJ, Moore A, Nussmeier NA, Ofili E, Oparil S, Ouyang P, Pinn VW, Sherif K, Smith SC Jr, Sopko G, Chandra-Strobos N, Urbina EM, Vaccarino V, Wenger NK (2011) Effectiveness-based guidelines for the prevention of cardiovascular disease in women–2011 update: a guideline from the American heart association. Circulation 123:1243–1262PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Mosca L, Barrett-Connor E, Wenger NK (2011) Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes. Circulation 124:2145–2154PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Vaccarino V, Parsons L, Every NR, Barron HV, Krumholz HM (1999) Sex-based differences in early mortality after myocardial infarction. National registry of myocardial infarction 2 participants. N Engl J Med 341:217–225PubMedCrossRefGoogle Scholar
  4. 4.
    Vaccarino V, Parsons L, Peterson ED, Rogers WJ, Kiefe CI, Canto J (2009) Sex differences in mortality after acute myocardial infarction: changes from 1994 to 2006. Arch Intern Med 169:1767–1774PubMedCentralPubMedGoogle Scholar
  5. 5.
    Vaccarino V, Krumholz HM, Yarzebski J, Gore JM, Goldberg RJ (2001) Sex differences in 2-year mortality after hospital discharge for myocardial infarction. Ann Intern Med 134:173–181PubMedCrossRefGoogle Scholar
  6. 6.
    Canto JG, Rogers WJ, Goldberg RJ, Peterson ED, Wenger NK, Vaccarino V, Kiefe CI, Frederick PD, Sopko G, Zheng ZJ (2012) Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA 307:813–822PubMedCentralPubMedGoogle Scholar
  7. 7.
    Galatius-Jensen S, Launbjerg J, Mortensen LS, Hansen JF (1996) Sex related differences in short and long-term prognosis after acute myocardial infarction: 10 year follow up of 3073 patients in database of first Danish Verapamil Infarction Trial. BMJ 313:137–140PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    White AD, Rosamond WD, Chambless LE, Thomas N, Conwill D, Cooper LS, Folsom AR (1999) Sex and race differences in short-term prognosis after acute coronary heart disease events: the atherosclerosis risk in communities (ARIC) study. Am Heart J 138:540–548PubMedCrossRefGoogle Scholar
  9. 9.
    Alfredsson J, Stenestrand U, Wallentin L, Swahn E (2007) Gender differences in management and outcome in non-ST-elevation acute coronary syndrome. Heart 93:1357–1362PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Fengler K, Fuernau G, Desch S, Eitel I, Neumann FJ, Olbrich HG, de Waha A, de Waha S, Richardt G, Hennersdorf M, Empen K, Hambrecht R, Fuhrmann J, Bohm M, Poess J, Strasser R, Schneider S, Schuler G, Werdan K, Zeymer U, Thiele H (2014) Gender differences in patients with cardiogenic shock complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial. Clin Res Cardiol 104:71–78PubMedCrossRefGoogle Scholar
  11. 11.
    McKinlay SM (1996) The normal menopause transition: an overview. Maturitas 23:137–145PubMedCrossRefGoogle Scholar
  12. 12.
    Cole JH, Miller JI 3rd, Sperling LS, Weintraub WS (2003) Long-term follow-up of coronary artery disease presenting in young adults. J Am Coll Cardiol 41:521–528PubMedCrossRefGoogle Scholar
  13. 13.
    Panagiotakos DB, Rallidis LS, Pitsavos C, Stefanadis C, Kremastinos D (2007) Cigarette smoking and myocardial infarction in young men and women: a case–control study. Int J Cardiol 116:371–375PubMedCrossRefGoogle Scholar
  14. 14.
    Egiziano G, Akhtari S, Pilote L, Daskalopoulou SS, Investigators G (2013) Sex differences in young patients with acute myocardial infarction. Diabet Med J Br Diabet Assoc 30:e108–e114CrossRefGoogle Scholar
  15. 15.
    McGill HC Jr, McMahan CA, Herderick EE, Zieske AW, Malcom GT, Tracy RE, Strong JP (2002) Obesity accelerates the progression of coronary atherosclerosis in young men. Circulation 105:2712–2718PubMedCrossRefGoogle Scholar
  16. 16.
    Chen TS, Incani A, Butler TC, Poon K, Fu J, Savage M, Dahl M, Callow DE, Colburn D, Hammett C, Walters DL (2014) The demographic profile of young patients (<45 years-old) with acute coronary syndromes in Queensland. Heart Lung Circ 23:49–55PubMedCrossRefGoogle Scholar
  17. 17.
    Hoit BD, Gilpin EA, Henning H, Maisel AA, Dittrich H, Carlisle J, Ross J Jr (1986) Myocardial infarction in young patients: an analysis by age subsets. Circulation 74:712–721PubMedCrossRefGoogle Scholar
  18. 18.
    Lewis WR, Ellrodt AG, Peterson E, Hernandez AF, LaBresh KA, Cannon CP, Pan W, Fonarow GC (2009) Trends in the use of evidence-based treatments for coronary artery disease among women and the elderly: findings from the get with the guidelines quality-improvement program. Circ Cardiovasc Qual Outcomes 2:633–641PubMedCrossRefGoogle Scholar
  19. 19.
    Nohria A, Vaccarino V, Krumholz HM (1998) Gender differences in mortality after myocardial infarction. Why women fare worse than men. Cardiol Clin 16:45–57PubMedCrossRefGoogle Scholar
  20. 20.
    Chandra NC, Ziegelstein RC, Rogers WJ, Tiefenbrunn AJ, Gore JM, French WJ, Rubison M (1998) Observations of the treatment of women in the United States with myocardial infarction: a report from the national registry of myocardial infarction-I. Arch Intern Med 158:981–988PubMedCrossRefGoogle Scholar
  21. 21.
    Hvelplund A, Galatius S, Madsen M, Rasmussen JN, Rasmussen S, Madsen JK, Sand NP, Tilsted HH, Thayssen P, Sindby E, Hojbjerg S, Abildstrom SZ (2010) Women with acute coronary syndrome are less invasively examined and subsequently less treated than men. Eur Heart J 31:684–690PubMedCrossRefGoogle Scholar
  22. 22.
    Jespersen L, Abildstrom SZ, Hvelplund A, Prescott E (2013) Persistent angina: highly prevalent and associated with long-term anxiety, depression, low physical functioning, and quality of life in stable angina pectoris. Clin Res Cardiol 102:571–581PubMedCrossRefGoogle Scholar
  23. 23.
    Khawaja FJ, Shah ND, Lennon RJ, Slusser JP, Alkatib AA, Rihal CS, Gersh BJ, Montori VM, Holmes DR, Bell MR, Curtis JP, Krumholz HM, Ting HH (2012) Factors associated with 30-day readmission rates after percutaneous coronary intervention. Arch Intern Med 172:112–117PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Gupta A, Wang Y, Spertus JA, Geda M, Lorenze N, Nkonde-Price C, D’Onofrio G, Lichtman JH, Krumholz HM (2014) Trends in acute myocardial infarction in young patients and differences by sex and race, 2001–2010. J Am Coll Cardiol 64:337–345PubMedCrossRefGoogle Scholar
  25. 25.
    Nguyen HL, Gore JM, Saczynski JS, Yarzebski J, Reed G, Spencer FA, Goldberg RJ (2010) Age and sex differences and 20-year trends (1986–2005) in prehospital delay in patients hospitalized with acute myocardial infarction. Circ Cardiovasc Qual Outcomes 3:590–598PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Melberg T, Kindervaag B, Rosland J (2013) Gender-specific ambulance priority and delays to primary percutaneous coronary intervention: a consequence of the patients’ presentation or the management at the emergency medical communications center? Am Heart J 166:839–845PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Melinda Davis
    • 1
  • Jamie Diamond
    • 1
  • Daniel Montgomery
    • 1
  • Sangeetha Krishnan
    • 1
  • Kim Eagle
    • 1
  • Elizabeth Jackson
    • 1
  1. 1.Division of Cardiovascular MedicineUniversity of MichiganAnn ArborUSA

Personalised recommendations