Impact of an invasive strategy on 5 years outcome in men and women with non-ST-segment elevation acute coronary syndromes

Joakim Alfredsson, Tim Clayton, Peter Damman, Keith A A Fox, Mats Fredriksson, Bo Lagerqvist, Lars Wallentin, Robbert J de Winter, Eva Swahn

Research output: Contribution to journalArticlepeer-review


BACKGROUND: A routine invasive (RI) strategy in non-ST-segment elevation acute coronary syndromes (NSTE ACS) has been associated with better outcome compared with a selective invasive (SI) strategy in men, but results in women have yielded disparate results. The aim of this study was to assess gender differences in long-term outcome with an SI compared with an RI strategy in NSTE ACS.

METHODS: Individual patient data were obtained from the FRISC II trial, ICTUS trial, and RITA 3 trial for a collaborative meta-analysis.

RESULTS: Men treated with an RI strategy had significantly lower rate of the primary outcome 5-year cardiovascular (CV) death/myocardial infarction (MI) compared with men treated with an SI strategy (15.6% vs 19.8%, P = .001); risk-adjusted hazards ratio (HR) 0.73 (95% CI 0.63-0.86). In contrast, there was little impact of an RI compared with an SI strategy on the primary outcome among women (16.5% vs 15.1%, P = .324); risk-adjusted HR 1.13 (95% CI 0.89-1.43), interaction P = .01. For the individual components of the primary outcome, a similar pattern was seen with lower rate of MI (adjusted HR 0.69, 95% CI 0.57-0.83) and CV death (adjusted HR 0.71, 95% CI 0.56-0.89) in men but without obvious difference in women in MI (adjusted HR 1.13, 95% CI 0.85-1.50) or CV death (adjusted HR 0.97, 95% CI 0.68-1.39).

CONCLUSIONS: In this meta-analysis comparing an SI and RI strategy, benefit from an RI strategy during long-term follow-up was confirmed in men. Conversely, in women, there was no evidence of benefit.

Original languageEnglish
Pages (from-to)522-9
Number of pages8
JournalAmerican Heart Journal
Issue number4
Publication statusPublished - Oct 2014


  • Acute Coronary Syndrome
  • Coronary Angiography
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Myocardial Revascularization
  • Treatment Outcome

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