Sex-based differences in patients with peripheral arterial disease admitted for acute coronary syndrome-Insights from a multicentre national registry

Abstract Atherosclerosis represents a systemic disease that can involve multiple vascular beds, including coronary artery disease and peripheral artery disease (PAD). Acute coronary syndrome (ACS) with concomitant PAD represents a high-risk subgroup that deserves special attention. In particular, sex-based differences in PAD treatment and outcomes have been discussed. This study aimed to clarify the main differences in clinical outcomes between women and men with PAD admitted for ACS. The authors performed a retrospective analysis of adult patients with PAD, included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between October 2010 and July 2022. A P-value < 0.05 is statistically significant. Of the total of 32 251 hospitalized patients admitted for ACS, 1588 (4.9%) had known PAD, of which 320 were women and 1268 men. Table 1 shows the most important baseline characteristics and differences between groups. After propensity score matching, with 640 patients, female gender appeared to be an independent factor for acute heart failure (OR 0.68, 95% CI [0.48, 0.96], P-value = 0.03) and in-hospital mortality (OR 0.36, 95% CI [0.17, 0.73], P-value < 0.01). However, there are no differences between sex for 1-year mortality (P-value = 0.70). In conclusion, in this group of patients, PAD is less prevalent among women, and probably underdiagnosed. In addition, there is a significant difference in medication with fewer women taking acetylsalicylic acid, probably undertreated. Finally, women have more in-hospital complications, including mortality. Hence, additional efforts are needed in order to better understand sex-based differences in PAD and increase awareness of this condition in women.