Impact of an invasive strategy on 5 years outcome in men and women with non-ST-segment elevation acute coronary syndromes.


Alfredsson, J; Clayton, T; Damman, P; Fox, KA; Fredriksson, M; Lagerqvist, B; Wallentin, L; de Winter, RJ; Swahn, E; (2014) Impact of an invasive strategy on 5 years outcome in men and women with non-ST-segment elevation acute coronary syndromes. American heart journal, 168 (4). pp. 522-9. ISSN 0002-8703 DOI: https://doi.org/10.1016/j.ahj.2014.06.025

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Abstract

BACKGROUND A routine invasive (RI) strategy in non-ST-segment elevation acute coronary syndromes (NSTE ACS) has been associated with better outcome compared with a selective invasive (SI) strategy in men, but results in women have yielded disparate results. The aim of this study was to assess gender differences in long-term outcome with an SI compared with an RI strategy in NSTE ACS. METHODS Individual patient data were obtained from the FRISC II trial, ICTUS trial, and RITA 3 trial for a collaborative meta-analysis. RESULTS Men treated with an RI strategy had significantly lower rate of the primary outcome 5-year cardiovascular (CV) death/myocardial infarction (MI) compared with men treated with an SI strategy (15.6% vs 19.8%, P = .001); risk-adjusted hazards ratio (HR) 0.73 (95% CI 0.63-0.86). In contrast, there was little impact of an RI compared with an SI strategy on the primary outcome among women (16.5% vs 15.1%, P = .324); risk-adjusted HR 1.13 (95% CI 0.89-1.43), interaction P = .01. For the individual components of the primary outcome, a similar pattern was seen with lower rate of MI (adjusted HR 0.69, 95% CI 0.57-0.83) and CV death (adjusted HR 0.71, 95% CI 0.56-0.89) in men but without obvious difference in women in MI (adjusted HR 1.13, 95% CI 0.85-1.50) or CV death (adjusted HR 0.97, 95% CI 0.68-1.39). CONCLUSIONS In this meta-analysis comparing an SI and RI strategy, benefit from an RI strategy during long-term follow-up was confirmed in men. Conversely, in women, there was no evidence of benefit.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
PubMed ID: 25262262
Web of Science ID: 343096900018
URI: http://researchonline.lshtm.ac.uk/id/eprint/1987635

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