TY - JOUR
T1 - Sex differences in the presentation and management of acute coronary syndrome patients
T2 - Insights from the FORCE-ACS registry
AU - Sivanesan, Shabiga
AU - Gąsecka, Aleksandra
AU - van der Sangen, Niels M.R.
AU - van den Broek, Wout W.A.
AU - Azzahhafi, Jaouad
AU - Chan Pin Yin, Dean R.P.P.
AU - van de Pol, Qiu Ying F.
AU - Walhout, Ronald J.
AU - Joe Gin, Melvyn Tjon
AU - Pisters, Ron
AU - Nicastia, Deborah M.
AU - de Roest, Gerben J.
AU - Vlachojannis, Georgios J.
AU - van Bommel, Rutger J.
AU - Kikkert, Wouter J.
AU - Henriques, José P.S.
AU - ten Berg, Jurriën M.
AU - Appelman, Yolande
N1 - Publisher Copyright:
© 2025 The Author(s)
PY - 2026/2
Y1 - 2026/2
N2 - Aims: This study reports sex differences in the clinical presentation, treatment management and outcomes of patients with acute coronary syndrome (ACS) in The Netherlands, using data from the FORCE-ACS registry. Methods: A prospective analysis was conducted using data from 5023 patients admitted with ACS between 2015 and 2019, with complete three-year follow-up. Demographic data, clinical characteristics, in-hospital treatment and outcomes were compared by sex. Multivariable regression analyses explored associations between sex and clinical outcomes. Results: Of the 5023 patients, 29 % were women. Women were generally older, with a significantly higher prevalence of hypertension (61.7 % vs 54.2 %), chronic kidney disease (25.7 % vs. 18.5 %) and myocardial infarction with non-obstructive coronary arteries (MINOCA) (13.5 % vs. 6.5 %). Women less frequently underwent revascularisation, even after excluding those with non-obstructive coronary artery disease, and received less medical treatment compared to their male counterparts. At 36 months, women had higher unadjusted mortality rate (13.7 % vs. 11.0 %, OR 1.28, 95 % CI: 1.07–1.54) and bleeding events (26.2 % vs. 22.3 %, OR 1.24, 95 % CI: 1.08–1.43). However, after adjustment for age and baseline characteristics, these differences were no longer statistically significant. Recurrent ACS and stroke remained similar in both groups, also after correction. Conclusion: Differences between women and men were observed in clinical presentation, interventional treatment, pharmacotherapy and outcomes among ACS patients in The Netherlands. Despite receiving less guideline-recommended care, women had similar adjusted 36-month outcomes as men. These findings show that there is room for improvement in the management of ACS, with a focus on optimized treatment strategies for women.
AB - Aims: This study reports sex differences in the clinical presentation, treatment management and outcomes of patients with acute coronary syndrome (ACS) in The Netherlands, using data from the FORCE-ACS registry. Methods: A prospective analysis was conducted using data from 5023 patients admitted with ACS between 2015 and 2019, with complete three-year follow-up. Demographic data, clinical characteristics, in-hospital treatment and outcomes were compared by sex. Multivariable regression analyses explored associations between sex and clinical outcomes. Results: Of the 5023 patients, 29 % were women. Women were generally older, with a significantly higher prevalence of hypertension (61.7 % vs 54.2 %), chronic kidney disease (25.7 % vs. 18.5 %) and myocardial infarction with non-obstructive coronary arteries (MINOCA) (13.5 % vs. 6.5 %). Women less frequently underwent revascularisation, even after excluding those with non-obstructive coronary artery disease, and received less medical treatment compared to their male counterparts. At 36 months, women had higher unadjusted mortality rate (13.7 % vs. 11.0 %, OR 1.28, 95 % CI: 1.07–1.54) and bleeding events (26.2 % vs. 22.3 %, OR 1.24, 95 % CI: 1.08–1.43). However, after adjustment for age and baseline characteristics, these differences were no longer statistically significant. Recurrent ACS and stroke remained similar in both groups, also after correction. Conclusion: Differences between women and men were observed in clinical presentation, interventional treatment, pharmacotherapy and outcomes among ACS patients in The Netherlands. Despite receiving less guideline-recommended care, women had similar adjusted 36-month outcomes as men. These findings show that there is room for improvement in the management of ACS, with a focus on optimized treatment strategies for women.
KW - Acute coronary syndrome
KW - Men
KW - Registry
KW - Sex differences
KW - Women
UR - https://www.scopus.com/pages/publications/105024193407
U2 - 10.1016/j.ijcha.2025.101849
DO - 10.1016/j.ijcha.2025.101849
M3 - Article
AN - SCOPUS:105024193407
SN - 2352-9067
VL - 62
JO - IJC Heart and Vasculature
JF - IJC Heart and Vasculature
M1 - 101849
ER -