"Perhaps the most striking findings in our analyses relate to the examination of mortality according to type of ACS. We found a significant interaction between sex and type of ACS, such that 30-day mortality risk among women was modestly higher than men only for those patients presenting with STEMI. In patients with NSTEMI and unstable angina, women had a lower adjusted 30-day mortality risk than men. In fact, the strongest finding after full adjustment was lower risk among women with unstable angina," the authors write.

The researchers also found that overall, women who underwent catheterization were more likely to have nonobstructive coronary artery disease and less likely to have multivessel disease compared with men. The relationship between sex and 30-day mortality was similar across the levels of angiographic disease severity.

"Our study suggests a better understanding of the observed sex-based differences. Sex-based differences exist in 30-day mortality among patients with ACS and vary depending on clinical presentation. However, these differences are markedly attenuated following adjustment for clinical differences and angiographic data. The attenuation in the difference in mortality suggests that much of the crude differences are explained by these factors. This study further highlights the clinical and angiographic differences among men and women at presentation with ACS. Understanding and considering these differences may lead to better risk stratification and treatment of all patients with ACS," the researchers conclude.

jama.ama-assn