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Impact of an invasive strategy on 5 years outcome in men and women with non-ST-segment elevation acute coronary syndromes
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
London School Hyg and Trop Med, England.
University of Amsterdam, Netherlands.
Royal Infirm, Scotland.
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2014 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 168, no 4, 522-529 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier , 2014. Vol. 168, no 4, 522-529 p.
National Category
Clinical Medicine
URN: urn:nbn:se:liu:diva-112177DOI: 10.1016/j.ahj.2014.06.025ISI: 000343096900018PubMedID: 25262262OAI: diva2:764235

Funding Agencies|Astra-Zeneca; Merck; Sharp Dome; Sanofi-Aventis; Sanofi-Aventis/Bristol-Myers Squibb; GlaxoSmithKline; Lilly; AstraZeneca

Available from: 2014-11-18 Created: 2014-11-18 Last updated: 2015-03-30

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Alfredsson, JoakimFredrikson, MatsSwahn, Eva
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Division of Cardiovascular MedicineFaculty of Health SciencesDepartment of Cardiology in LinköpingDivision of Inflammation Medicine
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