The Year in Cardiology 2018: Acute Coronary Syndromes

Petr Widimsky; Filippo Crea; Ronald K. Binder; Thomas F. Lüscher


Eur Heart J. 2019;40(3):271-282. 

In This Article

Acute Coronary Syndromes in Women

Radial vs. Femoral Access

Gargiulo et al sought to investigate the comparative efficacy and safety outcomes across sex of radial vs. femoral access in ACS patients participating in the MATRIXA-Access (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial. Among 8404 patients, 26.6% were women and 73.4% were men.[38] Men had a lower risk of access site bleeding [male vs. female rate ratio (RR) 0.64; P = 0.0016], severe bleeding (RR 0.17; P = 0.0012), and transfusion (RR 0.56; P = 0.0089). When comparing radial vs. femoral, there was no significant interaction for MACCE and NACE stratified by sex (P int = 0.15 and 0.18, respectively), although for both coprimary endpoints the benefit with transradial access was relatively greater in women (RR 0.73; P = 0.019; and RR 0.73; P = 0.012, respectively). Similarly, there was no significant interaction between male and female patients for the individual endpoints of all-cause death (P int = 0.79), MI (P int = 0.25), stroke (P int = 0.18), and Bleeding Academic Research Consortium Type 3 or 5 (P int = 0.45).

Sex Differences in High-intensity Statin use

Peters et al. studied 16 898 U.S. adults <65 years of age with commercial health insurance of which 26% were women and 71 358 U.S. adults >66 years of age with government health insurance of which 49% were women. They had filled statin prescriptions within 30 days after hospital discharge for MI.[39] The adjusted risk ratio for filling a high-intensity statin comparing women with men was 0.91 (95% CI 0.90–0.92). Women were less likely than men to fill high-intensity statins within all subgroups analysed, and the disparity was largest in the youngest and oldest adults and for those without prevalent comorbid conditions. Thus, despite recent efforts to reduce gender differences in guideline-recommended therapy, women continue to be less likely than men to fill a prescription for high-intensity statins following hospitalization for MI. The underlying reasons for this disparity require further study.