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Management of Non–ST-Elevation Acute Coronary Syndromes in Men vs. Women
In non–ST-elevation acute coronary syndromes (ACS), men and high-risk women benefit most from early invasive treatment, while low-risk women may fare better with conservative management, researchers conclude in JAMA.
A meta-analysis combined data from eight randomized trials comparing invasive management (angiography, with revascularization as needed) with a conservative approach (pharmacotherapy, with angiography for recurrent symptoms). Some 10,400 adults with unstable angina or non–ST-elevation MI were included.
Risk for the composite of death, nonfatal MI, and rehospitalization for ACS was significantly lower with invasive than with conservative management among men overall (odds ratio, 0.73) and women with elevated cardiac biomarkers (OR, 0.67), but not among biomarker-negative women (OR, 0.94). In addition, biomarker-negative women had a nonsignificant increase in risk for death or MI with invasive management (OR, 1.35).
The authors conclude: "Our data provide evidence supporting the new guideline recommendation for a conservative strategy in low-risk women."
LINK(S):
JAMA article (Free abstract; full text requires subscription)
Journal Watch Cardiology coverage of ACC/AHA guidelines (One-time registration required)
Published in Physician's First Watch July 2, 2008
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