Invasive treatment of coronary syndromes appears beneficial for men and high-risk women


Invasive treatment of coronary syndromes appears beneficial for men and high-risk women

An invasive treatment strategy, such as cardiac catheterization, could improve the chances avoiding later heart attack, rehospitalization, or death, according to a meta-analysis of previous studies, published on July 1, 2008 in JAMA.

Myocardial infarction (MI) or heart attack is caused by an interruption of blood flow to the heart muscle, usually due to blockage of the coronary artery. Cardiac catheterization involves the insertion of a wire into a major vessel, often in the groin, which is further guided into the area of the body requiring treatment. It can subsequently be used to perform a variety of techniques, including opening of blockages in the coronary arteries to prevent further heart attacks and death.

In patients with unstable angina and myocardial infarction (specifically non-ST-segment elevation myocardial infarction, or NSTEMI) invasive treatment strategies are frequently used in patients, but according to the background information in the article, some trials indicate that this might not benefit patients who are women, potentially giving them an increased risk of heart attack or death. The authors say that the invasive strategy might be ambiguously beneficial in women, but "individual trials have not been large enough to explore outcomes reliably within subgroups."

To evaluate the relative risks and benefits of invasive treatment in men and women, Michelle O'Donoghue, M.D., of Brigham and Women's Hospital and Massachusetts General Hospital, Boston, and colleagues performed a meta-analysis examining eight randomized trials in a review of medical literature. The data were combined for these trials, and several incidences were measured: death, myocardial infarction or heart attack, rehospitalization with unstable angina or heart attack (ACS). A total 10,150 patients were thus incorporated, comprising 3,075 women and 7,075 men. The data were further stratified by the presence of various high risk biomarkers.

For the purposes of the study, an invasive strategy was defined as referral of patients with heart attacks and unstable angina for cardiac catheterization. A conservative treatment strategy was defined by a primary strategy involving medical management and subsequent catheterization only when further symptoms, such as chest pain or a positive stress test, indicated the need for further treatment.

When administered an invasive strategy, both men and women showed a decreased risk of death, myocardial infarction, or unstable angina or heart attack in comparison to those given a conservative strategy. When biomarkers were observed, in biomarker-positive women, this risk was more significantly decreased than biomarker-negative women.

The authors suggest some action based on this informaiton: "Our data provide evidence to support the updated American College of Cardiology/American Heart Association guidelines that now recommend that a conservative strategy be used in low-risk women with non"ST-segment elevation acute coronary syndromes (NSTE ACS)," they write.

They conclude: "Combination of these data enabled us to explore the association of sex with outcomes both overall and within high-risk subgroups, whereas individual studies may be insufficiently powered in this regard. Future investigations should include novel methods for identifying women at high-risk of adverse outcomes after NSTE ACS and whose risk could be modifiable with an invasive approach."

Early Invasive vs Conservative Treatment Strategies in Women and Men With Unstable Angina and Non"ST-Segment Elevation Myocardial Infarction

Michelle O'Donoghue, MD; William E. Boden, MD; Eugene Braunwald, MD; Christopher P. Cannon, MD; Tim C. Clayton, MSc; Robbert J. de Winter, MD, PhD; Keith A. A. Fox, MB, ChB; Bo Lagerqvist, MD, PhD; Peter A. McCullough, MD, MPH; Sabina A. Murphy, MPH; Rudolf Spacek, MD, PhD; Eva Swahn, MD, PhD; Lars Wallentin, MD, PhD; Fons Windhausen, MD; Marc S. Sabatine, MD, MPH

JAMA. 2008;300(1):71-80.

Click Here For Abstract

Acute Coronary Syndromes (Video Medical And Professional 2020).

Section Issues On Medicine: Cardiology