Gender gap in acute coronary heart disease: Myth or reality?

Table 1 Mortality rates of coronary heart disease per 100 000 population by gender[3]

Country	Year1	Men 35-74 yr	Women 35-74 yr
United States	2007	153.3	60.4
The Netherlands	2008	66.2	22.8
England/Wales	2007	138.3	43.4
Denmark	2006	84.8	32.4
France	2007	48.4	12.2
Germany	2006	125.3	38.2
Italy	2007	75.6	22.2
Russian Federation	2006	706.0	237.1
China	2000	108.3	71.9
Japan	2008	47.6	13.8
Australia	2006	88.9	26.8
New Zealand	2005	138.4	47.2
Argentina	1996	140.3	39.4

¹Most recent year available.

Table 2 Prevalence of cardiovascular risk factors and history of myocardial infarction and cardiac surgery stratified by gender

Author	Design	Study population	Patients		Age (mean, yr)		P	Hypertension (%)		P	Diabetes (%)		P	Smoking (%)		P	History of MI (%)		P	History of cardiac surgery (%)			P
study/date			Men	Women	Men	Women		Men	Women		Men	Women		Men	Women		Men	Women			Men	Women
Reynolds et al[30] 2007	RCT	MI	12 498	4090	59.5	67.0	< 0.001	29.7	47.3	< 0.001	14.4	21.0	< 0.001	49.7	34.3	< 0.001	16.4	12.5	< 0.001	CABG	3.7	2.2	< 0.001
																				PCI	7.5	4.5	< 0.001
Moriel et al[28] 2005	Pros cohort	ACS	820	511	78	79	0.12	58	74	< 0.001	33	40	0.007	13	5	< 0.001	39	29	< 0.001	CABG	14	7	< 0.001
																				PCI	21	11	< 0.001
Herlitz et al[18] 2009	Retro cohort	AMI	835	588	72.7	79.2	< 0.0001	46	56	0.01	24	21	NS	22	16	NS	42	33	< 0.0001	CABG	10	7	0.06
																				PCI	7	5	0.32
Mehilli et al[54] 2002	Pros cohort	AMI	1435	502	60.7	70.3	< 0.001	61.0	72.9	< 0.001	18.0	25.3	< 0.001	43.1	25.9	< 0.001	22.1	16.3	0.001	CABG	6.1	3.4	0.02
																				PCI	10.7	7.6	0.04
Mueller et al[55] 2002	Pros cohort	MI	1033	417	64	68	0.01	60	72	0.01	19	23	0.15	33	21	0.01	37	24	0.01	CABG	17	6	0.01
																				PCI	24	21	0.20
Toumpoulis et al[34] 2006	Pros cohort	CABG	2598	1162	63.2	66.2	< 0.001	65.9	79.4	< 0.001	28.8	45.5	< 0.001	16.1	12.9	0.011	50.7	46.1	0.010	CABG	7.8	5.3	0.006
																				PCI	10.9	12.8	0.093
Dallongevillle et al[15] 2010	Pros cohort	ACS	6698	2268	62.2	65.8	< 0.0001	80.3	87.9	< 0.0001	33.6	38.4	0.009	19.3	11.0	< 0.0001	19.1	20.6	< 0.0001	CABG	20.4	17.2	< 0.0001
Anand et al[9] 2005	Trial	ACS	7726	4836	62.7	66.5	0.0001	53	68.8	0.0001	20.9	24.6	0.0001	76.4	37.4	0.0001	36.9	23.9	0.0001	CABG	13.3	6.8	0.0001
																				PCI	11.5	7.2	0.0001
Matsui et al[26] 2002	Retro cohort	AMI	346	136	62.9	70.4		44	54	0.047	25	33	0.078	60	19	0.001	18	15	0.517	CABG	1	1	0.556
																				PCI	12	4	0.016
Tizón-Marcos et al[33] 2009	RCT	PCI	1050	298	59.7	62.5		49	59	0.004	17	20	0.19	32	36	0.23	45	41	0.19	CABG	6.3	6.4	1.00
																				PCI	21	14	0.016
Reina et al[51] 2007	Pros cohort	AMI	4641	1568	64	71	< 0.01	41.0	61.1	< 0.01	25.5	41.2	< 0.01	53.6	15.7	< 0.01	16.6	13.0	< 0.01	Total	7.2	12.0	< 0.01
Thompson et al[53] 2006	Pros cohort	PCI	807	359	61.7	67.7	< 0.001	59.3	67.8	0.006	23.8	30.1	0.03	47.4	38.5	0.005	25.2	22.4	0.33	CABG	8.3	7.2	0.53
																				PCI	28.3	24.6	0.20
Lee et al[78]	Pros cohort	STEMI	2954	1083	60.7	72.1	< 0.001	40.2	59.7	< 0.001	23.1	31.4	< 0.001	58.8	14.7	< 0.001	3.6	2.9	0.239	CABG	0.5	0.3	0.330
2008																				PCI	4.3	2.8	0.023
Jankowski et al[46] 2007	Pros cohort	CAD + PCI	738	187	57.5	60.6	< 0.001	72.6	87.8	< 0.001	14.5	21.3	< 0.05	13.6	6.4	< 0.01	63.2	66.0	NS	CABG	1.5	0.5	NS
																				PCI	8.8	8.5	NS
Duvernoy et al[43] 2010	Pros cohort	PCI	14848	7877	61.9	66.9	< 0.001	71.0	82.5	< 0.001	29.2	38.5	< 0.001	27.3	21.7	< 0.001	36.0	32.6	< 0.001	CABG	21.5	17.4	< 0.001
																				PCI	41.8	38.9	< 0.001
Lansky et al[22] 2005	RCT	AMI + PTCA	1520	562	57.0	66.0	< 0.001	29.0	59.3	< 0.001	14.0	25.7	< 0.001	45.3	37.4	0.001	15.7	8.4	< 0.001	PCI	12.7	7.1	< 0.001
Lansky et al[67] 2009	RCT	PCI	687	314	61.8	65.9	< 0.0001	72.7	81.5	0.0026	25.7	36.3	0.0007	24.0	21.2	0.3711	21.9	13.6	0.0022	Total	34.1	25.5	0.0066
De Luca et al[41] 2004	Pros cohort	STEMI	1195	353	59	66	< 0.001	24	39	< 0.001	8.7	15.8	< 0.001	52.1	42.7	0.002	11.6	7.1	0.014	CABG	2.1	1.7	NS
																				PCI	5.3	1.7	0.004
De Luca et al[42] 2010	Trail	STEMI	1283	379	59	67	< 0.001	39.1	52.5	< 0.001	15.3	22.4	< 0.001	56	36.9	< 0.001	9.2	7.7	0.35	Total	7.7	7.6	0.93
Bufe et al[62]	Pros cohort	STEMI + PCI	376	124	58	65	< 0.001	66	54.8	0.055	11.2	24.2	< 0.001	67.3	40.3	< 0.001	11.7	8.9	0.479	CABG	5.6	0.8	0.046
2010																				PCI	5.6	4.0	0.658
Carrabba et al[40] 2004	Pros cohort	STEMI	627	293	67.7	76.3	0.001	45.3	60.1	< 0.001	22.7	25.3	0.385	34.1	14.3	< 0.001	17.2	14.7	0.331	CABG	2.6	1.0	0.129
																				PCI	5.9	2.1	0.010
Lawesson et al[24] 2010	Retro cohort	STEMI aged < 46	1748	384	40.8	40.4	0.14	13.9	21.7	< 0.001	12.4	18.5	0.002	58.0	63.9	0.04	6.6	5.2	0.30	CABG	0.8	0.3	0.25
																				PCI	2.5	1.9	0.46
Berger et al[10] 2006	Pros cohort	PCI	2953	1331	61.9	66.8	< 0.001	66	78	< 0.001	22	36	< 0.001	15	10	< 0.001	36	33	0.08	CABG	19	14	0.001
																				PCI	26	24	0.137
Chiu et al[13]	Pros cohort	PCI	12 738	5301	62.3	66.5	< 0.001	58	71	< 0.001	24	34	< 0.001	21	20	0.01	43	42	0.29	CABG	30	21	< 0.001
2004																				PCI	6	4	< 0.001
Koch et al[20]	Pros cohort	CABG	1588	460				51.7	70.2	0.0001	22.5	36.3	0.0001	71.5	49.6	0.0001	14.3	10.7	0.044	CABG	14.4	7.0	0.0001
2003																				PCI	15.4	16.3	0.6249
Setoguchi et al[31] 2008	Pros cohort	AMI	317	1308	80	82	< 0.001	71	80	0.001	33	39	0.03	15	10	0.01	52	37	< 0.001	CABG	18	13	0.03
																				PCI	13	9	0.02

MI: Myocardial infarction; AMI: Acute myocardial Infarction; PCI: Percutaneous coronary intervention; CABG: Coronary artery bypass grafting; ACS: Acute coronary syndrome; STEMI: ST elevation MI; CAD: Coronary artery disease; NS: Not significant.

Table 3 Extent of coronary artery disease stratified by gender

Author study/date	Design	Study population	Patients		Age (mean, yr)		P	1 vessel disease (%)		P	3 vessel disease (%)		P
			Men	Women	Men	Women		Men	Women		Men	Women
Lansky et al[22] 2005	RCT	AMI + PTCA	1520	562	57.0	66.0	< 0.001	51.1	51.6	NS	15.7	15.3	NS
Lansky et al[67] 2009	RCT	PCI	687	314	61.8	65.9	< 0.0001	61.3	74.2	< 0.0001	11.5	4.5	0.0002
Tizón-Marcos et al[33] 2009	RCT	PCI	1050	298	59.7	62.5		58	65	0.066	9.8	7.4	0.066
Hirakawa et al[19] 2007	Pros cohort	AMI	2048	566	62.92	71.08	< 0.01	60.1	56.0	< 0.05	34.81	40.11	< 0.05
Mueller et al[55] 2002	Pros cohort	MI	1033	417	64	68	0.01	24	26	0.45	42	29	0.01
Duvernoy et al[43] 2010	Pros cohort	PCI	14 848	7877	61.9	66.9	< 0.001	49.4	55.0	< 0.001	22.8	18.0	< 0.001
Liu et al[25] 2008	Pros cohort	STEMI + PCI	143	116	68.1	68.7	0.61	14.7	10.3	0.29	48.2	61.2	0.03
Jibran et al[81] 2010	Retro cohort	ACS + PCI	331	137	60.7	66.1	< 0.00001	41.1	48.9	0.3	22.7	12.4	0.3
De Luca et al[41] 2004	Pros cohort	STEMI	1195	353	59	66	< 0.001	47.9	43.8	NS	20.7	22.3	NS
Bufe et al[62] 2010	Pros cohort	STEMI + PCI	376	124	58	65	< 0.001	48.1	54.0	0.031	24.2	21.8	0.667
Lawesson et al[24] 2010	Retro cohort	STEMI aged < 46	1748	384	40.8	40.4	0.14	59.3	72.9	< 0.001	33.6	19.2	< 0.001
Berger et al[10] 2006	Pros cohort	PCI	2953	1331	61.9	66.8	< 0.001	48	50	0.195	18	17	NS
Toumpoulis et al[34] 2006	Pros cohort	CABG	2598	1162	63.2	66.2	< 0.001	4.6	7.3	0.001	73.7	69.3	0.005
Tillmanns et al[32] 2005	Pros cohort	STEMI	513	178	60	66	< 0.0001	43	44	NS	571	561	NS
Vakili et al[57] 2001	Retro cohort	PTCA first MI	727	317	59	65	< 0.005	56	59	NS	15	12	NS

¹More than single vessel disease. MI: Myocardial infarction; CABG: Coronary artery bypass grafting; STEMI: ST elevation MI; NS: Not significant.

Table 4 Percentage of performed revascularizations stratified by gender

Author study/date	Design	Study population	Patients		Age (mean, yr)		P	CABG (%)		P	PCI (%)		P
			Men	Women	Men	Women		Men	Women		Men	Women
Reynolds et al[30] 2007	RCT	MI	12 498	4090	59.5	67.0	< 0.001	3.4	3.1	0.45	27.4	23.6	< 0.01
Matsui et al[26] 2002	Retro cohort	AMI	346	136	62.9	70.4	0.01	4	7	0.179	95	84	0.001
Moriel et al[28] 2005	Pros cohort	ACS	820	511	78	79	0.12	7	6	0.47	32	28	0.06
Herlitz et al[18] 2009	Retro cohort	AMI	835	588	72.7	79.2	< 0.0001	9	2	< 0.0001	15	7	NS
Setoguchi et al[31] 2008	Pros cohort	AMI	317	1308	80	82	< 0.001	3	3	0.73	10	12	0.40
Tillmanns et al[32] 2005	Pros cohort	STEMI	513	178	60	66	< 0.0001	3	2	NS	95.1	93.8
Toumpoulis et al[34] 2006	Pros cohort	CABG	2598	1162	63.2	66.2	< 0.001	100	100		1.6	3.1	0.002
Berger et al[10] 2006	Pros cohort	PCI	2953	1331	61.9	66.8	< 0.001	0.1	0.0	0.179	100	100
Alfredsson et al[11] 2007	Pros cohort	Unstable/NSTEMI	34020	19761	69	73	< 0.001	7	5		18	14
Lagerqvist et al[21] 2001	RCT	AMI	1708	749	64	68	< 0.001	30	24		34	28
SoS[37] 2004	RCT	Multivessel disease	782	206	60.6	64.7	< 0.001	50.1	52.4		49.9	47.6
Singh et al[79] 2008	Retro cohort	PCI	7616	3365	64.7	69.4		0.8	0.8		100	100
Liu et al[25] 2008	Pros cohort	STEMI + PCI	143	116	68.1	68.7	0.61				85.3	84.3	NS

MI: Myocardial infarction; CABG: Coronary artery bypass grafting; PCI: Percutaneous coronary intervention; ACS: Acute coronary syndrome; STEMI: ST elevation MI; NS: Not significant.

Table 5 Percentage of peri-procedural complications during index admission stratified by gender

Author study/date	Design	Study population	Patients		Age (mean, yr)		P	Complications < admission (%)			P
			Men	Women	Men	Women			Men	Women
Lansky et al[22] 2005	RCT	AMI + PTCA	1520	562	57.0	66.0	< 0.001	MACE	3.2	6.4	0.002
								Bleeding	2.0	5.2	0.0003
Lansky et al[67] 2009	RCT	PCI	687	314	61.8	65.9	< 0.0001	MACE1	1.3	3.2	0.0766
								Vascular1	0.6	1.0	0.6844
								MI1	1.0	2.9	0.0526
Tizón-Marcos et al[33] 2009	RCT	PCI	1050	298	59.7	62.5	< 0.0001	MACE1	3.9	3.4	0.86
								Bleeding1	1.1	2.4	0.16
								MI1	3.5	3.0	0.86
Thompson et al[53] 2006	Pros cohort	PCI	807	359	61.7	67.7	< 0.0001	MACE	2.7	3.9	0.29
								Vascular	4.2	12.0	< 0.0001
Jibran et al[81] 2010	Retro cohort	ACS + PCI	331	137	60.7	66.1	< 0.0001	MACE1	3.9	2.9	0.8
								Access site1	1.5	6.2	0.02
								MI1	1.5	0.7	1.0
Duvernoy et al[43] 2010	Pros cohort	PCI	14 848	7877	61.9	66.9	< 0.001	MACE	4.48	5.19	< 0.001
								Vascular	1.02	3.34	< 0.001
								MI	1.60	1.66	0.70
Bufe et al[62] 2010	Pros cohort	STEMI + PCI	376	124	58	65	< 0.001	Shock	10.1	11.3	0.838
								Renal failure	1.3	1.6	0.835
Reynolds et al[30] 2007	RTC	MI	12 498	4090	59.5	67.0	< 0.001	CVA1	0.2	0.6	< 0.01
								Heart failure	4.0	6.7	< 0.001
								Re-MI	2.7	3.5	0.004
Matsui et al[26] 2002	Retro cohort	AMI	346	136	62.9	70.4		Heart failure	16	26	0.013
								Re-MI	5	6	0.568
Moriel et al[28] 2005	Pros cohort	ACS	820	511	78	79	0.12	CVA	2	1	0.79
								Heart failure	21	21	0.86
								Re-MI	15	14	0.61
Uva et al[35] 2009	RCT	CABG	1485	481	64.7	69.0	0.001	MACE	3.9	6.6	NS
								CVA	0.7	1.2	0.2
								MI	0.7	1.3	0.08
Herlitz et al[18] 2009	Retro cohort	AMI	835	588	72.7	79.2	< 0.0001	Re-MI	4	2	0.02
Toumpoulis et al[34] 2006	Pros cohort	CABG	2598	1162	63.2	66.2	< 0.001	CVA	2.8	4.2	NS
								Bleeding	1.8	1.5	0.592
								MI	0.6	0.7	0.657
Liu et al[25] 2008	Pros cohort	STEMI + PCI	143	116	68.1	68.7	0.61	MACE	4.2	6.0	0.50
Berger et al[10] 2006	Pros cohort	PCI	2953	1331	61.9	66.8	< 0.001	MACE	2.9	3.0	0.922
								CVA	0.1	0.2	0.905
								MI	1.6	1.7	NS
								Access site	0.0	0.3	0.018
Chiu et al[13] 2004	Pros cohort	PCI	12 738	5301	62.3	66.5	< 0.001	Transfusion	4	12	< 0.001
								Haematoma	5	6	0.568
Setoguchi et al[31] 2008	Pros cohort	AMI	317	1308	80	82	< 0.001	CVA	3	4	0.57
Singh et al[79] 2008	Retro cohort	PCI	7616	3365	64.7	69.4	0.48	CVA	0.5	0.9	0.29
								MI	1.1	1.4	0.44
Tillmanns et al[32] 2005	Pros cohort	STEMI	513	178	60	66	< 0.0001	Re-MI	3	2	NS

¹After 30 d. MI: Myocardial infarction; CABG: Coronary artery bypass grafting; PCI: Percutaneous coronary intervention; ACS: Acute coronary syndrome; STEMI: ST elevation MI; NS: Not significant; CVA: Cerebrovascular accident; MACE: Major adverse cardiac events.

Table 6 Mortality rates in male and female patients with coronary artery disease at admission, at thirty days and after one-year of follow-up

Author study/date	Design	Study population	Patients		Age (mean, yr)		P	Mortality < admission (%)		P	Mortality < 30 d (%)		P	Mortality < 1 year (%)		P
			Men	Women	Men	Women		Men	Women		Men	Women		Men	Women
Lansky et al[22] 2005	RCT	AMI + PTCA	1520	562	57.0	66.0	< 0.001	1.0	3.4	0.0003	1.1	4.6	< 0.001	3.0	7.6	< 0.001
Singh et al[79] 2008	Retro cohort	PCI	7616	3365	64.7	69.4	0.48	1.8	2.5	0.38	2	3	0.25	4	4	0.490
Alfredsson et al[11] 2007	Pros cohort	Unstable/NSTEMI	34 020	19 761	69	73	< 0.001	5	7		7	9		16	19
Setoguchi et al[31] 2008	Pros cohort	AMI	317	1308	80	82	< 0.001	14.5	13.9		9.8	8.6		21.5	18.2
														24.33	25.03
Matsui et al[26] 2002	RCT	MI	346	136	62.9	70.4		4	4	0.851	4	10	0.013
Uva et al[35] 2009	RCT	CABG	1485	481	64.7	69.0	0.001	0.8	2	0.01	1.2	2.3	0.09
Toumpoulis et al[34] 2006	Pros cohort	CABG	2598	1162	63.2	66.2	< 0.001	2.7	2.9	0.639	3.7	3.9	0.747
Moriel et al[28] 2005	Pros cohort	ACS	820	511	78	79	0.12	7	12	0.007				191	211	0.480
Herlitz et al[18] 2009	Retro cohort	AMI	835	588	72.7	79.2	< 0.0001	12	14	NS				18	22	0.040
Lawesson et al[24] 2010	Retro cohort	STEMI aged < 46	1748	384	40.8	40.4	0.14	1.0	2.9	0.005				2.2	3.7	0.010
Berger et al[10] 2006	Pros cohort	PCI	2953	1331	61.9	66.8	< 0.001	0.5	0.5	0.918				8.92	102	0.197
Liu et al[25] 2008	Pros cohort	STEMI + PCI	143	116	68.1	68.7	0.61	2.8	5.2					0	3.4
Anand et al[9] 2005	Trial	ACS	7726	4836	62.7	66.5	0.0001				4.9	4.4	0.235	11.1	9.7	0.040
Tizón-Marcos et al[33] 2009	RCT	PCI	1050	298	59.7	62.5	< 0.0001				0.2	0	1.00	0.8	1.0	0.720
Tillmanns et al[32] 2005	Pros cohort	STEMI	513	178	60	66	< 0.0001				6	6.2	NS	9	12.5	0.600
														122	182	0.070
Lansky et al[67] 2009	RCT	PCI	687	314	61.8	65.9	< 0.0001				0	0		1.0	0.3	0.447
Koch et al[20] 2003	Pros cohort	CABG	1588	460							2.5	3.4	0.29	4.21	7.11	0.020
														15.84	19.64	0.030
Lagerqvist et al[21] 2001	RCT	AMI	1708	749	64	68	< 0.001							5.7	7.2	NS
Chiu et al[13] 2004	Pros cohort	PCI	12 738	5301	62.3	66.5	< 0.001							5	7	< 0.001

¹After 6 mo;

²After 3 years;

³After 4 years;

⁴After 5 years;

⁵Adjusted for age, diabetes, smoking, history of cardiovascular disease, increased cardiac enzymes, region and received therapy. MI: Myocardial infarction; CABG: Coronary artery bypass grafting; PCI: Percutaneous coronary intervention; ACS: Acute coronary syndrome; STEMI: ST elevation MI; NS: Not significant.