Management and outcome of women with NSTEMI. Have there been any changes in recent years?

Abstract Introduction Women have been less represented in every NSTEMI clinical trial. Moreover, it has been observed that this group of patients have usually received less revascularization and evidence based treatment, therefore presenting with a greater long and short-term mortality. Purpose The purpose of our study is to analyze the presence of differences in baseline characteristics, management and outcome of women with NSTEMI during the last decade. Methods and results Retrospective study including 861 women admitted for NSTEMI between 2003 and 2015 in our center. We divided 2 groups according to hospitalization period (2003–2008 and 2009–2015) with a medium follow up of 4.5±2.9 years. Baseline characteristics and treatment at discharge are described on table 1. We noticed a greater use of statins and ACEI/ARB on the second period as well as a greater percentage of patients receiving early revascularization. It is remarkable on women a non-significant reduction of heart failure hospitalization at follow up (6.8% vs 4.5%; p=0.091), neither differences on 30-day mortality (1.3% vs 0,4%) or 1-year mortality (7.1% vs 5.8%). However, long-term mortality for the second group is reduced (HR 0.69; CI 95% 0.52–0.89), even after performing a multivariate analysis (HR 0.64; CI 95% 0.48–0.85). Characteristic Population (n=861) 2003–2008 (n=395) 2009–2015 (n=466) p-value Age (years) 73±12 73±12 72±12 0.316 Hypertension 629 (73.1%) 285 (72.2%) 344 (73.8%) 0.318 Hypercholesterolemia 414 (48.1%) 190 (48.1%) 224 (48.1%) 0.523 Killip class 0.292 I 664 (77.1%) 299 (75.7%) 365 (78.3%) II 143 (16.6%) 74 (18.7%) 69 (14.8%) III 47 (5.5%) 20 (5.1%) 27 (5.8%) IV 4 (0.5%) 2 (0.5%) 2 (0.4) GRACE score 129±32 130±37 128±33 0.897 Early PCI 249 (29.3%) 76 (19.2%) 173 (38.0%) <0.005 Treatment at discharge AAS 698 (81.1%) 313 (79.2%) 385 (82.6%) 0.120 Clopidogrel 465 (54.0%) 221 (55.9%) 244 (52.4%) 0.162 ACEI/ARB 466 (54.1%) 191 (48.4%) 275 (59.0%) 0.001 Beta-blocker 509 (59.1%) 238 (60.3%) 271 (58.2%) 0.290 Statins 643 (74.7%) 275 (69.6%) 368 (79.0%) 0.001 Conclusions In recent years, early interventionist management and greater use of evidence-based therapies have been observed in women with NSTEMI. This has been associated with a lesser long-term mortality, although short-term events have remained the same.