Improving outcomes in older women?

A n extensive body of research has reported that women experience worse outcomes compared with men when the full spectrum of acute coronary syndromes (ACS) are included (1–4). Compared with men, women are more likely to experience major bleeding (1,2) and vascular access complications (2) post-percutaneous coronary intervention, as well as a higher rate of major adverse cardiovascular events (1) and death (4) within 1 year post-ACS and beyond. Although the “high-risk” profile of women is well established, the degree to which this disparity is explained by differences in age and comorbidities remains an area of debate (1,3). This picture is complicated by the observation that the risk associated with female sex may differ by age strata and ACS subtype. An age–sex interaction has been described (4) whereby younger women, but not older women, experience worse outcomes than their age-matched male counterparts. In addition, a sex–ACS subtype interaction was found in a large sample of clinical trial participants (5), whereby women with ST-segment elevation acute coronary syndromes (STEACS) fared worse, and women with non–ST-segment elevation acute coronary syndromes (NSTEACS) fared better, than men with similar clinical presentations. Changing demographics have created an imperative to study outcomes in older adults with ACS, and understanding differences between older women and older men undergoing revascularization is one important area for exploration. To date, comparative effectiveness studies are limited