Significant predictors of poor prognosis in women aged ≤65 years hospitalized for an acute coronary event

Objectives. The aim of this study was to evaluate the importance of different clinical parameters predicting long-term cardiac prognosis in younger women with an acute coronary event. Design. The Stockholm Female Coronary Risk Study is a follow-up study in women less than or equal to65 years. Setting. Patients were included between 1991 and 1994 from all 10 coronary care or intensive care units in the greater Stockholm area. Subjects. A total of 335 consecutive female patients hospitalized for an acute coronary event. Main outcome measures. Cardiac death and nonfatal myocardial infarction (AMI). Results. During the follow-up period of 5 years there were 26 (8%) all cause deaths and 39 (12%) recurrent cardiac events. In the group that participated in the complete study, the following age adjusted parameters were found as strong predictors of adverse outcome: AMI as index event [Hazard Ratio (HR) 9.13, 95% CI 3.09-26.99], diabetes mellitus (HR 4.13, 95% CI 1.68-10.17), left ventricular dysfunction (HR 3.94, 95% CI 1.52-10.17), serum HDL cholesterol <1.0 mmol L-1 (HR 4.01, 95% CI 1.62-6.12), and serum triglycerides >2.0 mmol L-1 (HR 2.46, 95% CI 1.06-5.54). AMI as index event and diabetes mellitus were the most significant predictors in a multivariate statistical model. Diabetes mellitus was the strongest predictor when the analysis was repeated in the total patient cohort, integrating patients that did not participate in the extended investigations. Conclusions. Women aged less than or equal to65-year-old hospitalized for an acute coronary event has a low rate of cardiac events during the following 5-year period. Easily obtained clinical variables such as diabetes mellitus predict adverse prognosis and implicates a need for a more active diagnostic and treatment strategy.