CC Cardiol Croat Cardiologia Croatica Cardiol. Croat. 1848-543X 1848-5448 Croatian Cardiac Society CC_13(11-12)_438 10.15836/ccar2018.438 Extended Abstract Gender differences in outcomes during initial hospitalization and at 1-year follow-up of patients with acute coronary syndrome: experience from the Croatian branch of the ISACS-CT Registry Spolne razlike u unutarbolničkoj smrtnosti i smrtnosti nakon jedne godine praćenja bolesnika s akutnim koronarnim sindromom: iskustva iz Hrvatskog ogranka ISACS-CT registra https://orcid.org/0000-0002-7865-1108LončarićFilip1*https://orcid.org/0000-0003-4908-4674MjehovićPetra2https://orcid.org/0000-0002-7785-5555SabljakDorja3https://orcid.org/0000-0002-8483-3856MiškovićAntonija3https://orcid.org/0000-0002-9837-7214OrozDominik3https://orcid.org/0000-0003-1705-8295VinkovićInes3https://orcid.org/0000-0002-8021-4855VlahovićVedrana3https://orcid.org/0000-0002-7782-1646SalaiGrgur3https://orcid.org/0000-0002-3705-0226PavasovićSaša2https://orcid.org/0000-0001-7304-1127JakušNina2https://orcid.org/0000-0003-2633-3439FabijanovićDora2https://orcid.org/0000-0002-4772-5549ČikešMaja2https://orcid.org/0000-0001-9101-1570MiličićDavor2 Institut biomedicinskog istraživanja August Pi Sunyer (IDIBAPS), Barcelona, Španjolska Medicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska Medicinski fakultet Sveučilišta u Zagrebu, Zagreb, Hrvatska Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia School of Medicine, University of Zagreb, Zagreb, Croatia ADDRESS FOR CORRESPONDENCE: Filip Lončarić, Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036 Barcelona, Spain. / Phone: +385-91-2220-480 / E-mail: loncaric.filip@gmail.com 112018 13 11-12 438 439 2810201805112018 2018 Croatian Cardiac Society KLJUČNE RIJEČI: akutni koronarni sindromISACS-CT registarspolne razlikeishodi KEYWORDS: acute coronary syndromeISACS-CT registrygender differencesoutcomes

Background and Aim: Women with ST-segment elevation myocardial infarction (STEMI) have a higher 30-day risk of all-cause mortality. (1) The aim is to study gender differences in in-hospital mortality and mortality at 1-year follow-up in the Croatian branch of the ISACS-CT registry (NCT01218776).

Patients and Methods: From January 2012 to October 2017, 1898 patients were enrolled; 46% (n=881) presenting with STEMI, 36% (n=685) with non-ST-segment elevation myocardial infarction (NSTEMI), and 18% (n=332) with unstable angina (UA). Follow-up was performed on 33% (n=630) of the cohort, 44% (n=275) with STEMI, 34% (n=217) NSTEMI, and 22% (n=138) with UA.

Results: At admission women were older, more burdened with comorbidities, and arrived at the hospital with a longer delay from symptom onset (Figure 1). During hospitalization, there were no gender differences in reaching an ejection fraction (EF) below 40%. Nevertheless, women with STEMI had significantly worse outcomes in the acute period (Table 1). After adjusting for gender, in-hospital mortality was associated with age (OR 1.09, 95% CI 1.06-1.13, p<0.001) and primary percutaneous coronary intervention (PCI) (OR 0.45, 95% CI 0.24-0.86, p=0.015). At hospital discharge there was no gender difference in prescribed ACE-inhibitors or statins, whereas after 1-year there was a significant reduction in ACE-inhibitor (female vs. male: 68.3% vs. 81.1%, p=0.042) and statin therapy in women (Figure 2). During follow-up, 15.7% of patients reached <40% EF, 7.6% underwent repeated PCI, 2.7% were readmitted with NSTEMI or UA, 1.3% hospitalized for heart failure, 0.8% had a coronary artery bypass graft (CABG) procedure, 0.6% a stroke or a transitory ischemic attack, and 0.5% were readmitted with STEMI. There was no gender difference in all-cause mortality or in any of the endpoints. After adjustment for the type of acute coronary event at initial presentation and gender - age (HR 1.10, 95% CI 1.06-1.15, p<0.001), EF at discharge (HR 0.95, 95% CI 0.92-0.97, p<0.001) and primary PCI (HR 0.30, 95% CI 0.13-0.65, p=0.002) proved to be significant predictors of survival. 
Conclusion: Our results concur with the current findings of significantly increased in-hospital mortality of female STEMI patients. At 1-year follow-up there was no gender disproportion in mortality or other endpoints. A decrease in statin therapy was noted in women during follow-up, suggesting more through control might be needed to maintain the prescription of statins or compliance.

Gender differences in comorbidities and admission time in patients admitted due to acute coronary syndrome.

 Gender differences in mortality at hospital discharge and at 1-year follow-up.
STEMI NSTEMI Unstable Angina
Mortality Male Female P value Male Female P value Male Female P value
In-hospital, n (%) 25 (4.1) 32 (12.1) <0.001 15 (3.3) 9 (3.8) 0.827 4 (1.7) 0 (0) 0.261
1-year follow-up, n (%) 11 (5.7) 6 (7.4) 0.586 9 (6.3) 5 (6.8) 0.895 2 (1.9) 1 (3) 0.699
STEMI = ST-segment elevation myocardial infarction; NSTEMI = non-ST-segment elevation myocardial infarction.

Statin therapy over time in patients with acute coronary syndrome.

 LITERATURE BugiardiniRRicciBCenkoEVasiljevicZKedevSDavidovicG Delayed Care and Mortality Among Women and Men With Myocardial Infarction. J Am Heart Assoc. 2017 Aug 21;6(8):e005968. 10.1161/JAHA.117.00596828862963