Gender Differences in the Clinical Presentation, Management, and Prognosis of Acute Coronary Syndrome: A Single-Center Observational Study

Abstract

Gender differences in acute coronary syndrome (ACS) are widely recognised. Women may present with ACS at an older age and with a different cardiovascular risk profile, including higher prevalences of hypertension, diabetes, and renal insufficiency in many cohorts. They may also have differences in symptom presentation, coronary anatomy, management, and outcomes. The objective of this study was to compare, by sex, the clinical characteristics, cardiovascular risk factors, electrocardiographic findings, echocardiographic data, therapeutic management, and prognosis of patients admitted for ACS. We conducted a single-centre, retrospective, observational study including 94 patients hospitalised for ACS in the cardiology department of the Mohammed VI University Hospital in Marrakesh. Of the 94 patients included, 69 were men (73.4%) and 25 were women (26.6%). Women had a higher prevalence of hypertension and diabetes, whereas smoking was observed only among men. Mean left ventricular ejection fraction was similar between women and men. In-hospital mortality was 32.0% among women (8/25) and 7.2% among men (5/69), with an overall mortality of 13.8% (13/94). In multivariable logistic regression adjusted for age, diabetes, renal insufficiency, and left ventricular ejection fraction, female sex was associated with an odds ratio of 4.18 (95% CI, 1.14–15.37; p=0.032); however, given the small sample and limited number of events, this estimate should be considered exploratory. These findings should therefore be interpreted cautiously and viewed as hypothesis-generating rather than definitive evidence of an independent prognostic effect of sex.