Copyright © 2004 by the European Society of Cardiology.
Clinical research
Sex, age, and clinical presentation of acute coronary syndromes
a Department of Medicine, Goteborg University, Sahlgrenska University Hospital, Ostra, SE-416 85 Goteborg, Sweden
b University Hospital, Uppsala, Sweden
c Herzzentrum Ludwigshafen, Department of Cardiology, Institut for Herzinfarktforschung, Ludwigshafen, Germany
d Neufeld Cardiac Research Institute, Tel- Hashomer, Israel
e Rabin Medical Center, Petah Tikva, Israel
f Tel Aviv University, Israel
Received October 28, 2003;
revised February 15, 2004;
accepted February 19, 2004
* Corresponding author. Tel.: +46-31343-4000; fax: +46-31259-254
E-mail address: annika.rosengren{at}hjl.gu.se
Aim To investigate sex differences in clinical presentation in younger and older patients hospitalised with a wide spectrum of acute coronary syndromes (ACS).
Methods and results We analysed 10 253 patients with a discharge diagnosis of ACS in the Euro Heart Survey of patients with Acute Coronary Syndromes. There were 1010 women and 3709 men 
65 years. Among patients 65 years, fewer women than men presented with ST elevation, (OR [odds ratio]: 0.62 [0.53–0.71]) and developed Q-wave myocardial infarction (OR 0.58 [0.50–0.67]), whereas in patients 
65 years there was no significant sex difference. Women 65 years were more likely than men of the same age to be discharged with a diagnosis of unstable angina (OR 1.56 [1.35–1.79]), but there was no sex difference in older patients; the p for interaction between sex and age for both was 0.0001. Among patients who underwent coronary angiography, both younger and older women were less likely than men to have 3-vessel or main stem disease. In a logistic regression analysis stratified for age, female sex was a significant negative determinant of presenting with ST elevation in patients 65 years (OR 0.68 [0.58–0.79]), whereas there was no effect of sex in patients 65 years.
Conclusion In younger patients with ACS, women were less likely than men to present with ST elevation and more likely to be discharged with a diagnosis of unstable angina. In older patients there were no differences in clinical presentation. Both older and younger women had less extensive atherosclerosis. The findings suggest a different pathophysiology of ACS in younger, but not older, women.
Key Words: Myocardial infarction • Women • Sex • Age • Thrombolytic therapy • Coronary angiography
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