Specific Syndromes Unstable Angina

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Women and men who present with unstable angina have different coronary heart disease risk factors and clinical symptoms, yet have a similar rate of revascularization procedure utilization and mortality rates. One prospective registry followed 4305 men and 2847 women with unstable angina who were admitted to coronary care units in King County, Washington, between 1988 and 1994. Women were older and had a higher incidence of hypertensive heart disease and congestive heart failure than men, but had lower rates of tobacco use, previous myocardial infarction, and prior percutaneous intervention (112). Women were less likely to receive Agency for Health Care Policy Research (AHCPR) recommended pharmacologic treatment, diagnostic cardiac catheterization, and percutaneous or surgical coronary revascularization procedures than their male counterparts (113). Although women were more likely to require rehospitalization for recurrent symptoms than men, early and late mortality rates were similar after adjustment for age (112). By contrast, other studies have demonstrated a significant increase in mortality for women who present with unstable angina compared to men. In fact, women who present with unstable angina have in-hospital mortality rates that are reported to be up to 3X higher (9.3 vs 3.0%) than what is observed for men, accounting for a relative risk of 3.07. In logistic regression models, the association between gender and mortality was not significantly altered when corrected for age, ST-segment electrocardiogram changes, and coronary heart disease risk factors (114).

Interestingly, following an emergency department visit for the first presentation of unstable angina, women were less likely than men to undergo noninvasive and invasive diagnostic tests, and conversely, male sex was associated with a 24% increase in the use of cardiac procedures. Despite this utilization of resources, men had an increased risk of major adverse cardiac events compared to women (115).

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