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Early invasive vs c...
Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction : a meta-analysis
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O'Donoghue, Michelle (författare)
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Boden, William E. (författare)
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Braunwald, Eugene (författare)
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Cannon, Christopher P. (författare)
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Clayton, Tim C. (författare)
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de Winter, Robbert J. (författare)
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Fox, Keith A. A. (författare)
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- Lagerqvist, Bo, 1952- (författare)
- Uppsala universitet,Institutionen för medicinska vetenskaper,UCR
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McCullough, Peter A. (författare)
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Murphy, Sabina A. (författare)
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Spacek, Rudolf (författare)
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- Swahn, Eva, 1949- (författare)
- Östergötlands Läns Landsting,Linköpings universitet,Hälsouniversitetet,Kardiologi,Kardiologiska kliniken
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- Wallentin, Lars, 1943- (författare)
- Uppsala universitet,Institutionen för medicinska vetenskaper,UCR
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Windhausen, Fons (författare)
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Sabatine, Marc S. (författare)
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(creator_code:org_t)
- American Medical Association (AMA), 2008
- 2008
- Engelska.
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Ingår i: Journal of the American Medical Association (JAMA). - : American Medical Association (AMA). - 0098-7484 .- 1538-3598. ; 300:1, s. 71-80
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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https://urn.kb.se/re...
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Abstract
Ämnesord
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- 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.
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- MEDICINE
- MEDICIN
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- for (ämneskategori)
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O'Donoghue, Mich ...
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Boden, William E ...
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Braunwald, Eugen ...
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Cannon, Christop ...
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Clayton, Tim C.
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de Winter, Robbe ...
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Fox, Keith A. A.
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Lagerqvist, Bo, ...
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McCullough, Pete ...
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Murphy, Sabina A ...
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Spacek, Rudolf
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Swahn, Eva, 1949 ...
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Wallentin, Lars, ...
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Windhausen, Fons
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Sabatine, Marc S ...
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Uppsala universitet
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Linköpings universitet