Sex Differences in the Treatment and Outcome of Patients with Acute Coronary Syndrome After Percutaneous Coronary Intervention: A Population-Based Study

Abstract

Background:

This study was performed to assess the influence of sex on drug therapy and long-term outcomes in acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI).

Methods:

This is a retrospective cohort study of ACS patients who underwent PCI [women (n=8,884) and men (n=23,937)] between January 1, 2006, and December 31, 2007, with at least a 1-year follow-up, based on the National Health Insurance Research Database in Taiwan. Propensity score was used to identify a 1:1 matched cohort (n=17,768) for multivariable adjustment. The influence of sex on drug therapy and outcomes was examined by multivariate logistic regression and multivariable Cox proportional hazards regression.

Results:

Female patients had an 18% and 12% lower likelihood of receiving aspirin (adjusted odds ratio [OR_adj]=0.82, 95% confidence interval [CI]=0.77–0.88) and clopidogrel (OR_adj=0.88, 95% CI=0.81–0.95), respectively, than male patients but had a 17% and 22% higher likelihood of receiving beta-blockers (OR_adj=1.17, 95% CI=1.10–1.24) and statins (OR_adj=1.22, 95% CI=1.14–1.29), respectively, than male patients in the matched cohort. The adjusted hazard ratio (HR_adj) of rehospitalization for revascularization in women was 0.84 (95% CI=0.79–0.90) compared with men after at least a 1-year follow-up in the matched cohort.

Conclusions:

Female patients with ACS who underwent PCI were less likely to receive aspirin and clopidogrel but were more likely to receive beta-blockers and statins than male patients. Male sex was associated with a higher risk of rehospitalization for revascularization than female sex.