Christopher B. Granger, MD
In patients with non–ST-segment elevation myocardial infarction (NSTEMI) or unstable angina, does an early invasive strategy have similar benefits compared with a conservative strategy in men and women?
Studies selected compared an early invasive strategy (immediate coronary angiography followed by revascularization if appropriate) with a conservative strategy (primary pharmacologic management with coronary angiography reserved for patients with recurrent ischemia) in patients with NSTEMI or unstable angina. Studies were excluded if fibrinolytic therapy was administered to all patients or coronary angiography was required before enrollment. Outcomes were death, nonfatal MI, rehospitalization for acute coronary syndrome, and a composite of these 3 outcomes.
MEDLINE and Cochrane Library (to Apr 2008), and abstracts from major cardiology meetings were searched for peer-reviewed reports of adequately randomized controlled trials (RCTs). Experts were consulted. Sex-specific outcome data were provided by the authors of the original trials, if not given in the published reports. 8 RCTs involving 3152 women (mean age 64 y) and 7260 men (mean age 61 y) met the selection criteria.
Compared with a conservative strategy, an invasive strategy reduced a composite outcome of death, MI, or rehospitalization to a similar extent in men and women (Table). In both sexes, an invasive strategy reduced rehospitalizations for the acute coronary syndrome but not death or nonfatal MI (Table). Treatment effects were similar in patients with NSTEMI or unstable angina.
In patients with non–ST-segment elevation myocardial infarction or unstable angina, an early invasive strategy had similar benefits over a conservative strategy in men and women.
Early invasive vs conservative strategy in patients with non–ST-segment myocardial infarction (MI) or unstable angina*
*Abbreviations defined in Glossary. RRR, RRI, NNT, NNH, and CI calculated from data in article using a random-effects model.
†6 months in 1 trial.
Granger CB. Review: An early invasive strategy has similar benefits in men and women with NSTEMI or unstable angina. Ann Intern Med. ;149:JC5–7. doi: 10.7326/0003-4819-149-10-200811180-02007
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Published: Ann Intern Med. 2008;149(10):JC5-7.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine.
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