Sex-specific presentation, care, and clinical events in individuals admitted with NSTEMI: the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology.

BACKGROUND: Women have historically been disadvantaged in terms of care and outcomes for NSTEMI. We describe patterns of presentation, care, and outcomes for NSTEMI by sex in a contemporary and geographically diverse cohort.

METHODS: Prospective cohort study including 2947 patients (907 women, 2040 men) with Type I NSTEMI from 287 centres in 59 countries, stratified by sex. Quality of care was evaluated based on 12 guideline-recommended care interventions. The all-or-none scoring composite performance measure was used to define receipt of optimal care. Outcomes included acute heart failure, cardiogenic shock, repeat myocardial infarction, stroke/transient ischaemic attack, BARC Type ≥3 bleeding, or death in-hospital, as well as 30-day mortality.

RESULTS: Women admitted with NSTEMI were older, more comorbid and more frequently categorized as at higher ischaemic (GRACE >140, 54.0% vs 41.7%, p < 0.001) and bleeding (CRUSADE >40, 51.7% vs 17.6%, p < 0.001) risk than men. Women less frequently received invasive coronary angiography (ICA; 83.0% vs 89.5%, p < 0.001), smoking cessation advice (46.4% vs 69.5%, p < 0.001), and P2Y12 inhibitor prescription at discharge (81.9% vs 90.0%, p < 0.001). Non-receipt of ICA was more often due to frailty for women than men (16.7% vs 7.8%, p = 0.010). At ICA, more women than men had non-obstructive coronary artery disease or angiographically normal arteries (15.8% vs 6.3%, p < 0.001). Rates of in-hospital adverse outcomes and 30-day mortality were low and did not differ by sex.

CONCLUSIONS: In contemporary practice, women presenting with NSTEMI, compared with men, less frequently receive antiplatelet prescription, smoking cessation advice, or are considered eligible for ICA.