Abstract 1801: The Benefit of an Early Invasive Strategy in Women Versus Men with Non-ST-Elevation Acute Coronary Syndromes: A Collaborative Meta-Analysis of Randomized Trials
Background: Although an early invasive strategy (INV) is frequently used in patients with non-ST-elevation acute coronary syndromes (NSTEACS), some trials have shown this strategy to be associated with worse outcomes in women. We conducted a collaborative meta-analysis of randomized trials of INV vs. conservative strategy (CONS) stratified by gender and biomarker (CK-MB or troponin) elevation.
Methods: The principal investigators for each trial provided data on the incidence of death (D), non-fatal MI (MI) and rehospitalization with ACS by gender & biomarker elevation through long-term follow-up. Odds ratios from each trial were combined using a random-effects model with weighting based on inverse variance.
Results: Data were combined across 8 trials (3075 women, 7074 men). The OR for D/MI/ACS for INV vs. CONS was 0.83 in women (95% CI 0.68–1.01) and 0.75 in men (95% CI 0.58 – 0.98) with no significant heterogeneity between genders (P=0.54). In women, the benefit of INV tended to be greater in those with elevated biomarkers (OR 0.73, 0.58 – 0.92), compared with those without (OR 0.99, 0.67–1.47) (P interaction=0.19). In contrast, men benefited from INV irrespective of biomarker status (OR 0.78, 0.57–1.07 and OR 0.75, 0.58 – 0.98, P interaction=0.85). For patients in the INV arms, women were more frequently found to have no significant coronary artery disease (stenosis diameter <50%) at angiography than were men (27% vs 8%, P<0.001).
Conclusions: In patients with NSTEACS, an INV strategy reduces the composite of death, MI or rehospitalization with ACS to a similar extent in both women and men. Elevated biomarkers of necrosis may help identify women who benefit most from an INV strategy.