CLINICAL STUDY: MYOCARDIAL INFARCTION
Women do have an improved long-term outcome after non–ST-elevation acute coronary syndromes treated very early and predominantly with percutaneous coronary intervention
A prospective study in 1,450 consecutive patients
Christian Mueller, MD* ,*,
Franz-Josef Neumann, MD, FACC*,
Helmut Roskamm, MD, FACC*,
Peter Buser, MD, FACC,
John Mc. B. Hodgson, MD, FACC ,
Andrè P. Perruchoud, MD and
Heinz J. Buettner, MD*
* Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
University Hospital Basel, Basel, Switzerland
MetroHealth Medical Center, Cleveland, Ohio, USA
Manuscript received December 7, 2001;
revised manuscript received March 19, 2002,
accepted April 19, 2002.
* Reprint requests and correspondence: Dr. Christian Mueller, Medizinische Intensivstation, Medizinische Universitätsklinik, Petersgraben 4, CH-4031, Basel, Switzerland.
chmueller{at}uhbs.ch
OBJECTIVES: This study sought to assess gender-based differences in long-term outcome after very early aggressive revascularization for non–ST-elevation acute coronary syndromes (NSTACS).
BACKGROUND: The Fragmin and fast Revascularization during InStability in Coronary artery disease (FRISC) II study suggested that women have less to gain from an early invasive strategy.
METHODS: We conducted a prospective cohort study in 1,450 consecutive patients with NSTACS undergoing coronary angiography and subsequent coronary stenting of the culprit lesion as the primary revascularization strategy within 24 h of admission. The combined primary end point was defined as death or nonfatal myocardial infarction (MI) and recorded for a mean of 20 months.
RESULTS: Percutaneous coronary intervention was performed in more than 50% of patients in women and men and accompanied with stenting in 80%. The percutaneous coronary intervention:coronary artery bypass grafting ratio was 4:1 in men and 5:1 in women. The primary end point occurred in 29 (7.0%) women as compared with 108 (10.5%) men (hazard ratio for women, 0.65; 95% confidence interval [CI] 0.42 to 0.99; p = 0.045). Backward-stepwise multivariate Cox regression analysis identified female gender as an independent predictor of death or MI (hazard ratio for female gender, 0.51; 95% CI, 0.28 to 0.92; p = 0.024). Kaplan-Meier analysis showed that women had consistently lower event rates during the entire follow-up period (p = 0.037 by log-rank for death or MI).
CONCLUSIONS: Women treated with very early aggressive revascularization with coronary stenting of the culprit lesion as the primary revascularization strategy have a better long-term outcome as compared with men.
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Abbreviations and Acronyms
| | ACS | | acute coronary syndromes | | CABG | | coronary artery bypass grafting | | CAD | | coronary artery disease | | CI | | confidence interval | | CK | | creatine kinase | | ECG | | electrocardiogram | | FRISC | | Fragmin and fast Revascularization during InStability in Coronary artery disease study | | MI | | myocardial infarction | | NSTACS | | non–ST-elevation acute coronary syndrome | | PCI | | percutaneous coronary intervention | | TACTICS-TIMI 18 | | Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction 18 trial |
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