ORIGINAL STUDIES Gender and age differences in outcomes of patients with acute coronary syndromes referred for coronary angiography Barbara E. Stähli MD, MBA 1,2,3 | Manfred B. Wischnewsky PhD 4 | Philipp Jakob MD 1,2,3 | Roland Klingenberg MD 1 | Slayman Obeid MD 1 | Dik Heg PhD 5 | Lorenz Räber MD, PhD 6 | Stephan Windecker MD 6 | François Mach MD 7 | Baris Gencer MD 7 | David Nanchen MD 8 | Peter Jüni MD 5 | Ulf Landmesser MD 1,2,3 | Christian M. Matter MD 1 | Thomas F. Lüscher MD 1 | Willibald Maier MD 1 1 Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland 2 Department of Cardiology, Charité Berlin – University Medicine, Campus Benjamin Franklin, Berlin, Germany 3 DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany 4 FB Mathematics and Computer Science, University of Bremen, Bremen, Germany 5 Department of Clinical Research, Clinical Trials Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland 6 Department of Cardiology, Cardiovascular Center, University Hospital Bern, Bern, Switzerland 7 Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Geneva, Switzerland 8 Department of Ambulatory Care and Community Medicine, Lausanne University, Lausanne, Switzerland Correspondence Willibald Maier, MD, Department of Cardiology, University Heart Center, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland. Email: karmaiew@usz.uzh.ch Funding information Swiss National Science Foundation (33CM30- 124112), the Swiss Heart Foundation, the Fondation Leducq, and the Foundation for Cardiovascular Research – Zurich Heart House, Zurich, Switzerland. The SPUM consortium was supported by research grants from Eli Lilly, Indianapolis (USA); Astra-Zeneca, Baar; Medtronic, Tollachenaz; Merck, Sharpe & Dohme, Lucerne; Roche Diagnostics, Rotkreuz; Sanofi-Aventis, Vernier; and St Jude Medical, Zurich (all Switzerland). Abstract Objectives: The number of elderly patients undergoing coronary revascularization is steadily increasing, and data on the impact of gender on outcomes are scarce. This study sought to assess gender-related differences in outcomes in elderly patients with acute coronary syn- dromes (ACS). Methods: We investigated outcomes in elderly ACS patients referred for coronary angiography and prospectively enrolled in the Swiss ACS Cohort between December 2009 and October 2012. Adjudicated major adverse cardiovascular and cerebrovascular events (MACCE) included all-cause death, non-fatal myocardial infarction, clinically indicated repeat coronary revasculari- zation, definite stent thrombosis, and transient ischemic attack/stroke. Results: Among 2,168 patients recruited, 481 (22%) patients were >75 years of age (37% women). In patients >75 years, 1-year MACCE rates were 15% and 23% in women and men (OR 0.59, 95% CI 0.36–0.97, P = 0.04), respectively, and differences remained significant after adjustments for baseline variables (adjusted OR 0.48, 95% CI 0.26–0.90, P = 0.02). Women >75 years had a lower cardiovascular mortality (6% versus 12%, adjusted OR 0.31, 95% CI 0.12–0.81, P = 0.02). In patients ≤75 years, 1-year MACCE rates did not differ between gender (10% and 8% for women and men, adjusted OR 1.28, 95% CI 0.77–2.14, P = 0.34). Rates of TIMI major bleeding for women and men were 4% and 4% in patients >75 years (P = 0.96), and 5% and 3% in those ≤75 years (P = 0.11). Conclusions: The low rates of MACCE observed in elderly women in this patient cohort suggest that with current interventional strategies the gender gap in ACS management has been attenuated. KEYWORDS acute coronary syndrome, coronary artery disease, elderly patients, gender Received: 8 September 2017 Accepted: 30 May 2018 DOI: 10.1002/ccd.27712 Catheter Cardiovasc Interv. 2018;1–9. wileyonlinelibrary.com/journal/ccd © 2018 Wiley Periodicals, Inc. 1