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Sex differences in patients with acute coronary syndromes and non-obstructive coronary arteries: Presentation and outcome

  • Matthew G.L. Williams
    Affiliations
    Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HY, United Kingdom

    Bristol Medical School, Faculty of Health Sciences, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, United Kingdom
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  • Amardeep Dastidar
    Affiliations
    Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HY, United Kingdom
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  • Kate Liang
    Affiliations
    Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HY, United Kingdom

    Bristol Medical School, Faculty of Health Sciences, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, United Kingdom
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  • Thomas W. Johnson
    Affiliations
    Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HY, United Kingdom

    Bristol Medical School, Faculty of Health Sciences, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, United Kingdom
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  • Anna Baritussio
    Affiliations
    Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HY, United Kingdom
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  • Julian Strange
    Affiliations
    Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HY, United Kingdom
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  • Nikhil Joshi
    Affiliations
    Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HY, United Kingdom
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  • Stephen Dorman
    Affiliations
    Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HY, United Kingdom
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  • Estefania De Garate
    Affiliations
    Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HY, United Kingdom

    Bristol Medical School, Faculty of Health Sciences, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, United Kingdom
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  • Lucrezia Spagnoli
    Affiliations
    Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HY, United Kingdom
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  • Emiliano Fiori
    Affiliations
    Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HY, United Kingdom
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  • Christopher Lawton
    Affiliations
    Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HY, United Kingdom
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  • Giovanni Biglino
    Affiliations
    Bristol Medical School, Faculty of Health Sciences, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, United Kingdom
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  • Sven Plein
    Affiliations
    Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom

    School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom
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  • Chiara Bucciarelli-Ducci
    Correspondence
    Corresponding author at: Royal Brompton and Harefield Hospitals, Guys' and St Thomas' Hospitals NHS Trust, Hill End Rd, Harefield, Uxbridge UB9 6JH, United Kingdom.
    Affiliations
    Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HY, United Kingdom

    School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom

    Royal Brompton and Harefield Hospitals, Guys' and St Thomas' NHS Trust, London, United Kingdom
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Published:November 22, 2022DOI:https://doi.org/10.1016/j.ijcard.2022.11.032

      Highlights

      • All-cause mortality was 9.5% over a median follow up of 4.9 years.
      • There was no overall difference in mortality by sex.
      • Mortality is highest in the non-ischaemic group in both sexes.
      • Men were more likely to have a non-ischaemic aetiology on CMR driven by a higher incidence of myocarditis.

      Abstract

      Background

      A substantial number of patients present with a suspected ACS and non-obstructive coronary arteries; sex differences in these patients are not well understood.
      This study aims to evaluate the impact of sex on clinical presentation and outcome in patients with suspected acute coronary syndrome (ACS) and non-obstructive coronary arteries with a final diagnosis confirmed by cardiovascular magnetic resonance imaging (CMR).

      Methods

      Consecutive patients with ACS and non-obstructive coronary arteries (n = 719) with an unclear cause from a single tertiary centre who were referred for CMR were included. The primary endpoint was all-cause mortality.

      Results

      CMR was performed at a median time of 30 days after presentation and identified a diagnosis in 74% of patients. All-cause mortality was 9.5% over a median follow up of 4.9 years, with no significant difference between sexes (8.8% versus 10.1%; p = 0.456). Men were more likely to have non-ischaemic aetiology on CMR than women (55% v 41%, p < 0.001), but were equally likely to have an ischaemic cause (25% v 27%, p = 0.462). Age group (HR 1.58, p < 0.001) and LV ejection fraction (HR 0.98, p = 0.023) were independent predictors of mortality.

      Conclusions

      There is no difference in all-cause mortality between sexes in patients presenting with suspected ACS and non-obstructive coronary arteries.

      Keywords

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