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  • O'Donoghue, Michelle (author)

Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction : a meta-analysis

  • Article/chapterEnglish2008

Publisher, publication year, extent ...

  • American Medical Association (AMA),2008
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:uu-104753
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-104753URI
  • https://doi.org/10.1001/jama.300.1.71DOI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-44754URI

Supplementary language notes

  • Language:English
  • Summary in:English

Part of subdatabase

Classification

  • Subject category:ref swepub-contenttype
  • Subject category:for swepub-publicationtype

Notes

  • CONTEXT: Although an invasive strategy is frequently used in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS), data from some trials suggest that this strategy may not benefit women. OBJECTIVE: To conduct a meta-analysis of randomized trials to compare the effects of an invasive vs conservative strategy in women and men with NSTE ACS. DATA SOURCES: Trials were identified through a computerized literature search of the MEDLINE and Cochrane databases (1970-April 2008) using the search terms invasive strategy, conservative strategy, selective invasive strategy, acute coronary syndromes, non-ST-elevation myocardial infarction, and unstable angina. STUDY SELECTION: Randomized clinical trials comparing an invasive vs conservative treatment strategy in patients with NSTE ACS. DATA EXTRACTION: The principal investigators for each trial provided the sex-specific incidences of death, myocardial infarction (MI), and rehospitalization with ACS through 12 months of follow-up. DATA SYNTHESIS: Data were combined across 8 trials (3075 women and 7075 men). The odds ratio (OR) for the composite of death, MI, or ACS for invasive vs conservative strategy in women was 0.81 (95% confidence interval [CI], 0.65-1.01; 21.1% vs 25.0%) and in men was 0.73 (95% CI, 0.55-0.98; 21.2% vs 26.3%) without significant heterogeneity between sexes (P for interaction = .26). Among biomarker-positive women, an invasive strategy was associated with a 33% lower odds of death, MI, or ACS (OR, 0.67; 95% CI, 0.50-0.88) and a nonsignificant 23% lower odds of death or MI (OR, 0.77; 95% CI, 0.47-1.25). In contrast, an invasive strategy was not associated with a significant reduction in the triple composite end point in biomarker-negative women (OR, 0.94; 95% CI, 0.61-1.44; P for interaction = .36) and was associated with a nonsignificant 35% higher odds of death or MI (OR, 1.35; 95% CI, 0.78-2.35; P for interaction = .08). Among men, the OR for death, MI, or ACS was 0.56 (95% CI, 0.46-0.67) if biomarker-positive and 0.72 (95% CI, 0.51-1.01) if biomarker-negative (P for interaction = .09). CONCLUSIONS: In NSTE ACS, an invasive strategy has a comparable benefit in men and high-risk women for reducing the composite end point of death, MI, or rehospitalization with ACS. In contrast, our data provide evidence supporting the new guideline recommendation for a conservative strategy in low-risk women.

Subject headings and genre

  • MEDICINE
  • MEDICIN

Added entries (persons, corporate bodies, meetings, titles ...)

  • Boden, William E. (author)
  • Braunwald, Eugene (author)
  • Cannon, Christopher P. (author)
  • Clayton, Tim C. (author)
  • de Winter, Robbert J. (author)
  • Fox, Keith A. A. (author)
  • Lagerqvist, Bo,1952-Uppsala universitet,Institutionen för medicinska vetenskaper,UCR(Swepub:uu)bolager (author)
  • McCullough, Peter A. (author)
  • Murphy, Sabina A. (author)
  • Spacek, Rudolf (author)
  • Swahn, Eva,1949-Östergötlands Läns Landsting,Linköpings universitet,Hälsouniversitetet,Kardiologi,Kardiologiska kliniken(Swepub:liu)evasw45 (author)
  • Wallentin, Lars,1943-Uppsala universitet,Institutionen för medicinska vetenskaper,UCR(Swepub:uu)larswall (author)
  • Windhausen, Fons (author)
  • Sabatine, Marc S. (author)
  • Uppsala universitetInstitutionen för medicinska vetenskaper (creator_code:org_t)

Related titles

  • In:Journal of the American Medical Association (JAMA): American Medical Association (AMA)300:1, s. 71-800098-74841538-3598

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