Background: The outcome of patients with acute coronary syndrome improved during the last years, however there is conflicting data on sex differences in ACS-related outcome, with some reports suggesting less improved prognosis in women. We therefore sought to investigate changes of incidence, related interventions, and outcome in females and males diagnosed with ACS in the past decade in Germany.
Methods: For the analyses, all ACS cases in the years 2005 to 2015 were collected from the Federal Bureau of Statistics in Germany. Procedures as coronary angiography and percutaneous coronary intervention, as well as in-hospital mortality were assessed by sex. Analyses were performed separately for the diagnoses ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina pectoris. Age-adjusted incidence rates were calculated.
Results: In total, 1,366,045 females and 2,431,501 males presenting with ACS were recorded. Females were older compared to males (73.1 vs 66.4 years), had a longer mean hospital stay (7.7 vs 6.9 days), received less often coronary angiographies (55.2% vs 66.2%) and coronary interventions (34.6% vs 46.7%). The age-adjusted incidence rate of ACS was lower in females than in males and showed a decrease from 2005 to 2015 in both sexes. Over time, the rate of performed coronary angiographies and interventions increased in females and males. The age-adjusted in-hospital mortality was substantially higher in females compared to males but decreased in both sexes over time (in females 87.2 to 71.0 cases per 1,000 person-years and in males 57.5 to 51.3 cases per 1,000 person-years) (Figure).
Conclusion: Evaluating all ACS patients hospitalized in Germany within the past decade, we found that women had a lower incidence of ACS compared to men, but a higher in-hospital mortality.


Figure: Incidence of in-hospital mortality cases per 1,000 person-years ranging from 2005 to 2015, adjusted for age.