Impact of gender on short-term and long-term all-cause mortality in patients with non-ST-segment elevation acute coronary syndromes: a meta-analysis

A meta-analysis to determine the impact of gender on mortality in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS): PubMed, EMBASE, and Cochrane Library, was systematically searched. Two investigators independently reviewed retrieved articles and assessed eligibility. Unadjusted mortality rates or adjusted effect estimates regarding gender-specific short-term and long-term all-cause mortality were identified. A total of 30 studies involving 358,827 patients with NSTE-ACS (129, 632 women and 229,195 men) were identified. In the unadjusted analysis, women had significantly higher risk of short-term all-cause mortality (RR 1.37; 95% CI 1.26–1.49; P < 0.00001) and long-term all-cause mortality (RR 1.18; 95% CI 1.07–1.31; P = 0.001) compared with men. However, when a meta-analysis was performed using adjusted effect estimates, the association between women and higher risk of short-term mortality (RR 0.99; 95% CI 0.91–1.07; P = 0.74) and long-term all-cause mortality (RR 0.84; 95% CI 0.68–1.03; P = 0.09) was markedly attenuated. Adjusted short-term and long-term all-cause mortality appeared similar in women and men. In conclusion, women with NSTE-ACS have higher short-term and long-term mortality compared with men. However, gender differences do not differ following adjustment for baseline cardiovascular risk factors and clinical differences.