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J Am Coll Cardiol, 2001; 38:41-48
© 2001 by the American College of Cardiology Foundation
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CLINICAL STUDY

Is early invasive treatment of unstable coronary artery disease equally effective for both women and men?

Bo Lagerqvist, MD, PhD*, K.åge Säfström, MD, PhD{dagger}, Elisabeth Ståhle, MD, PhDc, Lars Wallentin, MD, PhD*, Eva Swahn, MD, PhD{dagger} the FRISC II Study Group Investigators

* Cardiology, University Hospital, Uppsala, Sweden
c Department of Thoracic Surgery, University Hospital, Uppsala, Sweden
{dagger} Department of Cardiology, University Hospital, Linköping, Sweden

Manuscript received November 21, 2000; revised manuscript received March 21, 2001, accepted April 2, 2001.

Reprint requests and correspondence: Dr. Bo Lagerqvist, Department of Cardiology, Cardiothoracic Center, University Hospital, S-75 185 Uppsala, Sweden
bo.lagerqvist{at}card.uas.lul.se

BACKGROUND

The Fragmin and fast Revascularization during InStability in Coronary artery disease (FRISC II) trial compared the effectiveness of an early invasive versus a noninvasive strategy in terms of the incidence of death and myocardial infarction (MI) in patients with unstable coronary artery disease (CAD).

OBJECTIVES

In this subanalysis, we sought to evaluate gender differences in the effect of these different strategies.

METHODS

The patients (749 women and 1,708 men) were randomized to early invasive or noninvasive strategies. Coronary angiography was performed within the first 7 days in 96% and 10% of the invasive and noninvasive groups, respectively, and revascularization was performed within the first 10 days in 71% and 9% of the invasive and noninvasive groups, respectively.

RESULTS

Women presenting with unstable CAD were older, but fewer had previous infarctions, left ventricular dysfunction and elevated troponin T levels. Women had fewer angiographic changes. There was no difference in MI or death at 12 months among women in the invasive and noninvasive groups (12.4% vs. 10.5%, respectively), in contrast to the favorable effect in the invasively treated group of men (9.6% vs. 15.8%, p < 0.001). In an interaction analysis, there was a different effect of the early invasive strategy for the two genders (p = 0.008).

CONCLUSIONS

Women with symptoms and/or signs of unstable CAD are older, but still have less severe CAD and a better prognosis compared with men. In contrast to its beneficial effect in men, an early invasive strategy did not reduce the risk of future events among women. Further research is warranted to identify the most appropriate treatment strategy in women with unstable CAD.

Abbreviations and Acronyms
  CABG = coronary artery bypass graft surgery
  CAD = coronary artery disease
  CK-MB = creatine kinase-MB isoenzyme
  FRISC = Fragmin and fast Revascularization during InStability in Coronary artery disease study
  LMCA = left main coronary artery
  MI = myocardial infarction
  PCI = percutaneous coronary intervention




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