Comparison of clinical characteristics, in-hospital course, and 12-month prognosis in women and men with chronic coronary syndromes.

BACKGROUND: The prognosis of men and women with chronic coronary syndromes (CCS) remains ambiguous. AIMS: This study aimed to compare the clinical characteristics and 12­month prognosis of women and men with CCS included in the prospective single­center registry. METHODS: The study was based on the Prospective Registry of Stable Angina Management and Treatment (PRESAGE) including 11 021 patients with CCS hospitalized between 2006 and 2016 and subjected to coronary angiography. The composite endpoint included all­cause death, nonfatal myocardial infarction, acute coronary syndrome with revascularization, unstable coronary artery disease, or stroke. RESULTS: Women were older than men (mean [SD] age, 66.6 [9] vs 63.5 [9.6] years; P <0.001). Arterial hypertension (85.8% vs 79%; P <0.001) and type 2 diabetes (38.2% vs 33.7%; P <0.001) were more often diagnosed in women compared with men. Multivessel disease or left main disease were more frequent in men. Percutaneous coronary intervention and coronary artery bypass grafting were more often performed in men than in women (47.1% vs 36%, P <0.001 and 10.6% vs 6.1%, P <0.001, respectively). At 12­month follow­up, the composite endpoint was more frequently reached in men (7.4% vs 10.2%; P <0.001), including death (3.3% vs 4.5%; P = 0.002). In multivariable analysis, sex was not an independent predictor of the composite endpoint (hazard ratio, 1.08; 95% CI, 0.89-1.31, P = 0.45). CONCLUSIONS: Women and men with CCS differ in terms of the incidence of risk factors and revascularization treatments received. In men, a higher frequency of death and the composite endpoint was noted at 12­month follow­up. However, sex was not an independent predictor of patient outcomes at 12 months.

Long-term outcomes of 11 021 patients with chronic coronary syndromes and after coronary angiography: the PRESAGE registry.

INTRODUCTION: There is a paucity of real­world registries concerning patients with chronic coronary syndromes (CCS). OBJECTIVES: We aimed to assess the long­term outcomes of patients with CCS and after coronary angiography performed in accordance with the treatment strategy. PATIENTS AND METHODS: The analysis involved 11 021 patients treated in a single center between 2006 and 2016 who were enrolled into the ongoing PRESAGE registry. Based on the results of coronary angiography and the treatment strategy adopted, patients were classified into 4 groups: with nonsignificant lesions (n = 3637), undergoing percutaneous coronary intervention (n = 4678), undergoing coronary artery bypass grafting (CABG; n = 997), and receiving conservative treatment (notwithstanding significant lesions on an angiogram; n = 1709). All­cause death, assessed in every study group at 1-, 3-, and 5­year follow­up, was regarded as the primary outcome measure. RESULTS: The mean (SD) age of the study patients was 64.6 (9.5) years, and women constituted 35% of the cohort. Patients treated conservatively were the oldest (mean [SD] age, 64.9 [9.3] years) in the group and showed the highest prevalence of previous myocardial infarction (50.5%), CABG (31.8%), diabetes (40.3%), chronic total occlusion (65.5%), and left ventricular ejection fraction below 35% (24.4%). Death from any cause in patients with nonsignificant lesions, undergoing percutaneous coronary intervention, undergoing CABG, and receiving conservative treatment occurred 5 years following the index hospitalization in 11.2%, 16.2%, 9.7%, and 21% of those patients, respectively. CONCLUSIONS: The PRESAGE registry provides valuable information about the clinical characteristics and long­term outcomes of patients with CCS. The population of CCS patients is heterogeneous, and long­term prognosis is also varied. The poorest characteristics and outcomes were reported in patients with significant lesions and ineligible for revascularization procedures.

Coronary artery disease in women.

Cardiovascular diseases, including coronary artery disease (CAD), are the leading cause of death among women and men. Mortality among women is higher than in men. Women more often report atypical anginal symptoms. Non-invasive diagnostic testing of CAD is less sensitive and characteristic in women than in men. Coronary angiography and rewascularization of coronary arteries is less common in women. However, women, who undergo angiography have lower rates of obstructive CAD. The worse prognosis of CAD in women is associated with the fact that the onset of obstructive coronary artery disease in women occurs 7-10 years later than in men. Older women are also more often burdened with comorbidities. The aim of this study was to compare the clinical characteristics, diagnostics, and treatment of CAD in women and men.