Sex differences in patients with acute coronary syndromes and non-obstructive coronary arteries: Presentation and outcome

Matthew G L Williams; Amardeep Dastidar; Kate Liang; Thomas W Johnson; Anna Baritussio; Julian Strange; Nikhil Joshi; Stephen Dorman; Estefania De Garate; Lucrezia Spagnoli; Emiliano Fiori; Christopher Lawton; Giovanni Biglino; Sven Plein; Chiara Bucciarelli-Ducci

doi:10.1016/j.ijcard.2022.11.032

Sex differences in patients with acute coronary syndromes and non-obstructive coronary arteries: Presentation and outcome

Matthew G L Williams, Amardeep Dastidar, Kate Liang, Thomas W Johnson, Anna Baritussio, Julian Strange, Nikhil Joshi, Stephen Dorman, Estefania De Garate, Lucrezia Spagnoli, Emiliano Fiori, Christopher Lawton, Giovanni Biglino, Sven Plein, Chiara Bucciarelli-Ducci

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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Abstract

BACKGROUND: A substantial number of patients present with a suspected ACS and non-obstructive coronary arteries; sex differences in these patients are not well understood. This study aims to evaluate the impact of sex on clinical presentation and outcome in patients with suspected acute coronary syndrome (ACS) and non-obstructive coronary arteries with a final diagnosis confirmed by cardiovascular magnetic resonance imaging (CMR).

METHODS: Consecutive patients with ACS and non-obstructive coronary arteries (n = 719) with an unclear cause from a single tertiary centre who were referred for CMR were included. The primary endpoint was all-cause mortality.

RESULTS: CMR was performed at a median time of 30 days after presentation and identified a diagnosis in 74% of patients. All-cause mortality was 9.5% over a median follow up of 4.9 years, with no significant difference between sexes (8.8% versus 10.1%; p = 0.456). Men were more likely to have non-ischaemic aetiology on CMR than women (55% v 41%, p < 0.001), but were equally likely to have an ischaemic cause (25% v 27%, p = 0.462). Age group (HR 1.58, p < 0.001) and LV ejection fraction (HR 0.98, p = 0.023) were independent predictors of mortality.

CONCLUSIONS: There is no difference in all-cause mortality between sexes in patients presenting with suspected ACS and non-obstructive coronary arteries.

Original language	English
Pages (from-to)	15-22
Number of pages	8
Journal	International Journal of Cardiology
Volume	372
Early online date	24 Nov 2022
DOIs	https://doi.org/10.1016/j.ijcard.2022.11.032
Publication status	E-pub ahead of print - 24 Nov 2022

Bibliographical note

Funding Information:
The study was kindly supported by grants from the Rosetrees Trust , James Tudor Foundation and Above and Beyond Charitable Trust . In addition, CBD was in part supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (2010−2021). SP is funded by a British Heart Foundation Chair ( CH/16/2/32089 ). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care .

Publisher Copyright:
© 2022 Elsevier B.V.

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Williams, M. G. L., Dastidar, A., Liang, K., Johnson, T. W., Baritussio, A., Strange, J., Joshi, N., Dorman, S., De Garate, E., Spagnoli, L., Fiori, E., Lawton, C., Biglino, G., Plein, S., & Bucciarelli-Ducci, C. (2022). Sex differences in patients with acute coronary syndromes and non-obstructive coronary arteries: Presentation and outcome. International Journal of Cardiology, 372, 15-22. Advance online publication. https://doi.org/10.1016/j.ijcard.2022.11.032

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title = "Sex differences in patients with acute coronary syndromes and non-obstructive coronary arteries: Presentation and outcome",

abstract = "BACKGROUND: A substantial number of patients present with a suspected ACS and non-obstructive coronary arteries; sex differences in these patients are not well understood. This study aims to evaluate the impact of sex on clinical presentation and outcome in patients with suspected acute coronary syndrome (ACS) and non-obstructive coronary arteries with a final diagnosis confirmed by cardiovascular magnetic resonance imaging (CMR).METHODS: Consecutive patients with ACS and non-obstructive coronary arteries (n = 719) with an unclear cause from a single tertiary centre who were referred for CMR were included. The primary endpoint was all-cause mortality.RESULTS: CMR was performed at a median time of 30 days after presentation and identified a diagnosis in 74% of patients. All-cause mortality was 9.5% over a median follow up of 4.9 years, with no significant difference between sexes (8.8% versus 10.1%; p = 0.456). Men were more likely to have non-ischaemic aetiology on CMR than women (55% v 41%, p < 0.001), but were equally likely to have an ischaemic cause (25% v 27%, p = 0.462). Age group (HR 1.58, p < 0.001) and LV ejection fraction (HR 0.98, p = 0.023) were independent predictors of mortality.CONCLUSIONS: There is no difference in all-cause mortality between sexes in patients presenting with suspected ACS and non-obstructive coronary arteries.",

author = "Williams, {Matthew G L} and Amardeep Dastidar and Kate Liang and Johnson, {Thomas W} and Anna Baritussio and Julian Strange and Nikhil Joshi and Stephen Dorman and {De Garate}, Estefania and Lucrezia Spagnoli and Emiliano Fiori and Christopher Lawton and Giovanni Biglino and Sven Plein and Chiara Bucciarelli-Ducci",

note = "Funding Information: The study was kindly supported by grants from the Rosetrees Trust , James Tudor Foundation and Above and Beyond Charitable Trust . In addition, CBD was in part supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (2010−2021). SP is funded by a British Heart Foundation Chair ( CH/16/2/32089 ). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care . Publisher Copyright: {\textcopyright} 2022 Elsevier B.V.",

year = "2022",

month = nov,

day = "24",

doi = "10.1016/j.ijcard.2022.11.032",

language = "English",

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Williams, MGL , Dastidar, A , Liang, K , Johnson, TW, Baritussio, A, Strange, J, Joshi, N, Dorman, S, De Garate, E, Spagnoli, L, Fiori, E, Lawton, C, Biglino, G, Plein, S & Bucciarelli-Ducci, C 2022, 'Sex differences in patients with acute coronary syndromes and non-obstructive coronary arteries: Presentation and outcome', International Journal of Cardiology, vol. 372, pp. 15-22. https://doi.org/10.1016/j.ijcard.2022.11.032

TY - JOUR

T1 - Sex differences in patients with acute coronary syndromes and non-obstructive coronary arteries

T2 - Presentation and outcome

AU - Williams, Matthew G L

AU - Dastidar, Amardeep

AU - Liang, Kate

AU - Johnson, Thomas W

AU - Baritussio, Anna

AU - Strange, Julian

AU - Joshi, Nikhil

AU - Dorman, Stephen

AU - De Garate, Estefania

AU - Spagnoli, Lucrezia

AU - Fiori, Emiliano

AU - Lawton, Christopher

AU - Biglino, Giovanni

AU - Plein, Sven

AU - Bucciarelli-Ducci, Chiara

N1 - Funding Information: The study was kindly supported by grants from the Rosetrees Trust , James Tudor Foundation and Above and Beyond Charitable Trust . In addition, CBD was in part supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (2010−2021). SP is funded by a British Heart Foundation Chair ( CH/16/2/32089 ). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care . Publisher Copyright: © 2022 Elsevier B.V.

PY - 2022/11/24

Y1 - 2022/11/24

N2 - BACKGROUND: A substantial number of patients present with a suspected ACS and non-obstructive coronary arteries; sex differences in these patients are not well understood. This study aims to evaluate the impact of sex on clinical presentation and outcome in patients with suspected acute coronary syndrome (ACS) and non-obstructive coronary arteries with a final diagnosis confirmed by cardiovascular magnetic resonance imaging (CMR).METHODS: Consecutive patients with ACS and non-obstructive coronary arteries (n = 719) with an unclear cause from a single tertiary centre who were referred for CMR were included. The primary endpoint was all-cause mortality.RESULTS: CMR was performed at a median time of 30 days after presentation and identified a diagnosis in 74% of patients. All-cause mortality was 9.5% over a median follow up of 4.9 years, with no significant difference between sexes (8.8% versus 10.1%; p = 0.456). Men were more likely to have non-ischaemic aetiology on CMR than women (55% v 41%, p < 0.001), but were equally likely to have an ischaemic cause (25% v 27%, p = 0.462). Age group (HR 1.58, p < 0.001) and LV ejection fraction (HR 0.98, p = 0.023) were independent predictors of mortality.CONCLUSIONS: There is no difference in all-cause mortality between sexes in patients presenting with suspected ACS and non-obstructive coronary arteries.

AB - BACKGROUND: A substantial number of patients present with a suspected ACS and non-obstructive coronary arteries; sex differences in these patients are not well understood. This study aims to evaluate the impact of sex on clinical presentation and outcome in patients with suspected acute coronary syndrome (ACS) and non-obstructive coronary arteries with a final diagnosis confirmed by cardiovascular magnetic resonance imaging (CMR).METHODS: Consecutive patients with ACS and non-obstructive coronary arteries (n = 719) with an unclear cause from a single tertiary centre who were referred for CMR were included. The primary endpoint was all-cause mortality.RESULTS: CMR was performed at a median time of 30 days after presentation and identified a diagnosis in 74% of patients. All-cause mortality was 9.5% over a median follow up of 4.9 years, with no significant difference between sexes (8.8% versus 10.1%; p = 0.456). Men were more likely to have non-ischaemic aetiology on CMR than women (55% v 41%, p < 0.001), but were equally likely to have an ischaemic cause (25% v 27%, p = 0.462). Age group (HR 1.58, p < 0.001) and LV ejection fraction (HR 0.98, p = 0.023) were independent predictors of mortality.CONCLUSIONS: There is no difference in all-cause mortality between sexes in patients presenting with suspected ACS and non-obstructive coronary arteries.

U2 - 10.1016/j.ijcard.2022.11.032

DO - 10.1016/j.ijcard.2022.11.032

M3 - Article (Academic Journal)

C2 - 36427606

SN - 0167-5273

VL - 372

SP - 15

EP - 22

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

Sex differences in patients with acute coronary syndromes and non-obstructive coronary arteries: Presentation and outcome

Abstract

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