Acute Coronary Syndrome in Women: A 10-Year Review

As pharmacists’ ability to tease out more comprehensive information from clinical trials has increased, it has become evident that social and biologic factors interact to produce paradoxical health differences between men and women, especially on cardiovascular outcomes.

A study published by a team of Israeli researchers in the November 2014 issue of the American Journal of Medicine explored temporal trends among women hospitalized for acute coronary syndrome (ACS). While the research indicated that ACS outcomes in women have improved over the last decade, time from symptom onset to emergency room care has not.

The investigators used data on 2710 women enrolled in the 10-year Acute Coronary Syndrome Israeli Surveys. After dividing the data into early (2000-2004) and late (2006-2010) periods, they evaluated changes in the clinical characteristics, management strategies, and outcomes of the women enrolled.

Between 2000 and 2010, the frequency of women presenting with ST-elevation myocardial infarction (STEMI) with ACS declined from 25% to 22%, but comorbidities increased. The finding of fewer STEMIs differed from most studies that have shown increases, and the finding of more comorbidity was noteworthy because the mean age at ACS onset was unchanged, so older age did not explain the increase.

The time delay from symptom onset to emergency room visit was similar in the early and late periods, hovering around 2 hours. The goal of a door-to-balloon time of ≤90 minutes—a time designated optimal to decrease cardiac muscle damage due to localized hypoxia—also did not change.

Most women were significantly more likely to receive evidence-based cardiovascular therapies in 2010 than they were in 2000, including percutaneous coronary intervention. Women admitted to the hospital in the later period were much more likely to have significant reductions in 30-day major adverse cardiac events and 1-year mortality, compared with those admitted in the study’s early years.

Although comorbidities were increased and time to admission was unchanged among women hospitalized with ACS, the investigators noted that management strategies improved over the last decade and may have contributed to better outcomes.