Are There Different Effects of Invasive Treatment Between Women and Men During the Acute Stage of Unstable Coronary Artery Disease?
(English)Manuscript (preprint) (Other academic)
OBJECTIVES The FRISC II invasive trial compared an early invasive versus a noninvasive strategy concerning death and MI in CAD. This paper deals with the gender perspective in the same study.
METHODS There were 749 women and 1708 men included in the study with a mean age of 66 and 64 years in women and men respectively. The patients were randomized to early invasive or noninvasive strategy and to placebo controlled long-term low molecular mass (1mm) heparin ( dalteparin) treatment for 3 months. Coronary angiographies were performed within the first seven days in 96 % and 10 % and revascularisation was performed within the first 10 days in 71 % and 9 % in the invasive and noninvasive groups, respectively.
RESULTS Women were older but had less previous infarctions, better left ventricular function and less frequently had elevated troponin-levels. There were more patients with normal coronary arteries and less severe coronary artery lesions amongst the women. Accordingly, less interventions were performed in the female group although, among those who were revascularized, there was. no significant difference in the choice of procedure compared to men. There was no difference in the composite endpoint of MI and death at 12 months amongst women (12.4 vs. 10.5% in the invasive and non-invasive groups respectively) in contrast to the very favorable effect of the invasively treated group amongst the men (9.6 vs. 15.8%, p<0.001). In a multivariate interaction analysis there was different effect of early invasive strategy in the two genders (p=0.008)
CONCLUSIONS Women with symptoms and/or signs of unstable coronary artery disease are older but still have less severe CAD and a better prognosis than men. In contrast to men, an early invasive strategy did not reduce the risk for future events amongst women. Further research is warranted to identify the most appropriate treatment strategy in women with unstable CAD.
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-79933OAI: oai:DiVA.org:liu-79933DiVA: diva2:544730