ABSTRACT
OBJECTIVES: To investigate for trends in sex-related differences in the invasive diagnostic-therapeutic cascade in a population of patients with acute coronary syndromes (ACS). DESIGN: A nationwide cohort study. SETTING: Administrative and clinical registries covering all hospitalisations, invasive cardiac procedures and deaths in the Danish population of 5.6 million inhabitants. PARTICIPANTS: We included 52,565 patients aged 30-90 years who were hospitalised with a first ACS from January 2005 to November 2011. Follow-up was 60 days from the day of index admission. MAIN OUTCOME MEASURES: Diagnostic coronary angiography, percutaneous coronary intervention or coronary artery bypass within 60 days of index admission. RESULTS: Women constituted 36%, were older, had more comorbidity and were less likely to be admitted to a hospital with cardiac catheterisation facilities than men. Mortality rates were similar for both sexes. Diagnostic coronary angiography was performed less frequently on women compared with men, both within 1 day (31% vs 42%; p<0.001) and within 60 days (67% vs 80%; p<0.001), yielding adjusted female-male HRs of 0.83 (0.79-0.87) and 0.86 (0.84-0.89), respectively.Among the 39,677 patients undergoing coronary angiography, non-obstructive coronary artery disease was more frequent among women than men (22% vs 9%; p<0.001). Women were less likely to undergo percutaneous coronary intervention (58% vs 72%; p<0.001) and coronary artery bypass (6% vs 11%, p<0.001) within 60 days than men, yielding adjusted HRs of 0.96 (0.92-0.99) and 0.81 (0.74-0.89), respectively. The sex-related differences were not attenuated over time for any of the invasive cardiac procedures (p values for trend >0.05). CONCLUSIONS: In this nationwide study, men were more likely to undergo an invasive approach than women when hospitalised with a first ACS--a difference persisting from 2005 to 2011. Future studies should focus on the potential mechanisms behind this differential treatment.
Subject(s)
Acute Coronary Syndrome/diagnostic imaging , Acute Coronary Syndrome/therapy , Acute Coronary Syndrome/mortality , Age Factors , Aged , Aged, 80 and over , Angioplasty, Balloon, Coronary , Cardiac Catheterization , Comorbidity , Coronary Angiography , Coronary Artery Bypass , Denmark/epidemiology , Female , Humans , Male , Middle Aged , Patient Transfer , Registries , Sex FactorsABSTRACT
OBJECTIVES: To investigate the importance of vessel size on outcome differences by comparing the effects of drug-eluting stents (DES) versus bare-metal stents (BMS) in women and men with large coronary vessels. METHODS: All 2314 BASKET-PROVE patients randomized to DES versus BMS were followed for 2 years with a primary endpoint of major adverse cardiac events (MACE: cardiac death, non-fatal myocardial infarction, target-vessel revascularization). Cox proportional hazard models were used to evaluate the relative risk for women and men, respectively. All comparisons were adjusted for vessel size. RESULTS: Age, risk factors and complexity of coronary artery disease differed between women and men. DES reduced MACE rates at 2 years compared to BMS--in women: 4% vs. 15%, p<0.0001 with a hazard ratio (HR) of 0.27 (0.15-0.51), and men: 6% vs. 10%, p=0.003 (HR=0.60 (0.43-0.84)), respectively. The association persisted in both women (HR=0.25 (0.13-0.46)) and men (HR=0.60 (0.42-0.84)) following multivariable adjustments. A significant gender-treatment interaction was present (p=0.02). The reduced risk of MACE following DES vs. BMS implantation was present until 6 months in both women (HR=0.15 (0.06-0.36)) and men (HR=0.32 (0.17-0.59)) and remained significant until 2 years in women (HR=0.36 (0.15-0.87)), but not in men (HR=0.87 (0.49-1.55)). CONCLUSIONS: In women and men with similarly sized large coronary arteries, DES reduced 2-year MACE rates compared to BMS, but the significant gender-treatment interaction indicated a greater benefit of DES in women. Thus, factors other than vessel size seem to determine this gender difference.
Subject(s)
Coronary Vessels/pathology , Coronary Vessels/surgery , Drug-Eluting Stents , Metals , Sex Characteristics , Aged , Female , Follow-Up Studies , Humans , Male , Metals/administration & dosage , Middle Aged , Prospective Studies , Risk Factors , Stents , Treatment OutcomeABSTRACT
In 22 hypertensive patients with unilateral renal artery stenosis (RAS) and in 8 patients with unilateral or bilateral renal or renal arterial disease, plasma renin activity (PRA), renin substrate (PRS), and angiotensin II (AT II) concentrations were measured in both renal veins and in a peripheral vein 1-2 h after stimulation of renin secretion by injection of frusemide. In patients with elevated PRA in venous blood from a kidney with RAS, AT II was either also elevated, lower than or equal to PRA in peripheral blood, while the contralateral kidney almost invariably extracted AT II. In the 8 patients with variable renal diseases, the concordance between PRA and AT II measurements was better. Results suggest that AT II measurements in renal venous blood are less useful in assessing the functional significance of a RAS than those of PRA. Since PRS is not different in venous plasma of the diseased and the normal kidney, PRA measurements can be regarded as proportional to plasma renin concentration in this condition.
