Joakim Alfredsson1, Tim Clayton2, Peter Damman3, Keith A A Fox4, Mats Fredriksson5, Bo Lagerqvist6, Lars Wallentin6, Robbert J de Winter3, Eva Swahn5. 1. Department of Cardiology and Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden. Electronic address: joakim.alfredsson@liu.se. 2. London School of Hygiene and Tropical Medicine, London, United Kingdom. 3. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 4. Cardiovascular Research, Department of Medical and Radiological Sciences, Royal Infirmary, Edinburgh, United Kingdom. 5. Department of Cardiology and Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden. 6. Department of Cardiology, Cardiothoracic Centre, University Hospital, Uppsala, Sweden.
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.
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.
Authors: Anthony A Bavry; Islam Y Elgendy; Ahmed Mahmoud; Manoj P Jadhav; Tianyao Huo; Marian C Limacher; Carl J Pepine Journal: Cardiol Ther Date: 2015-12-12