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Sex Differences in ...
Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease : Insights From the ISCHEMIA Trial
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- Reynolds, Harmony R. (author)
- NYU Grossman Sch Med, New York, NY USA.
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- Cyr, Derek D. (author)
- Duke Clin Res Inst, Durham, NC USA.
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- Bairey Merz, C. Noel (author)
- Cedars Sinai Smidt Heart Inst, Los Angeles, CA USA.
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- Shaw, Leslee J. (author)
- Icahn Sch Med Mt Sinai, Cardiovasc Res Fdn, New York, NY USA.
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- Chaitman, Bernard R. (author)
- St Louis Univ, Sch Med, St Louis, MO USA.
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- Boden, William E. (author)
- VA New England Healthcare Syst, Bedford, MA USA.
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- Alexander, Karen P. (author)
- Duke Clin Res Inst, Durham, NC USA.
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- Rosenberg, Yves D. (author)
- NHLBI, Bethesda, MD USA.
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- Bangalore, Sripal (author)
- NYU Grossman Sch Med, New York, NY USA.
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- Stone, Gregg W. (author)
- Icahn Sch Med Mt Sinai, Cardiovasc Res Fdn, New York, NY USA.
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- Held, Claes, 1956- (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi
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- Spertus, John (author)
- Univ Missouri Kansa City UMKC, St Lukes Mid Amer Heart Inst, Kansas City, MO USA.
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- Goetschalckx, Kaatje (author)
- UZ Leuven, Dept Cardiovasc Dis, Leuven, Belgium.
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- Bockeria, Olga (author)
- Natl Res Ctr Cardiovasc Surg, Moscow, Russia.
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- Newman, Jonathan D. (author)
- NYU Grossman Sch Med, New York, NY USA.
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- Berger, Jeffrey S. (author)
- NYU Grossman Sch Med, New York, NY USA.
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- Elghamaz, Ahmed (author)
- Royal Brompton Hosp, Northwick Pk Hosp, London, England.
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- Lopes, Renato D. (author)
- Duke Clin Res Inst, Durham, NC USA.
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- Min, James K. (author)
- Cleerly Inc, New York, NY USA.
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- Berman, Daniel S. (author)
- Cedars Sinai Med Ctr, Los Angeles, CA USA.
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- Picard, Michael H. (author)
- Massachusetts Gen Hosp, Boston, MA USA.;Harvard Med Sch, Boston, MA USA.
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- Kwong, Raymond Y. (author)
- Brigham & Womens Hosp, Boston, MA USA.
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- Harrington, Robert A. (author)
- Stanford Univ, Dept Med, Sch Med, Stanford, CA USA.
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- Thomas, Boban (author)
- Hosp Cruz Vermelha Portuguesa, Lisbon, Portugal.
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- O'Brien, Sean M. (author)
- Duke Clin Res Inst, Durham, NC USA.
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- Maron, David J. (author)
- Stanford Univ, Dept Med, Sch Med, Stanford, CA USA.
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- Hochman, Judith S. (author)
- NYU Grossman Sch Med, New York, NY USA.
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NYU Grossman Sch Med, New York, NY USA Duke Clin Res Inst, Durham, NC USA. (creator_code:org_t)
- John Wiley & Sons, 2024
- 2024
- English.
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In: Journal of the American Heart Association. - : John Wiley & Sons. - 2047-9980. ; 13:5
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Abstract
Subject headings
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- BackgroundWomen with chronic coronary disease are generally older than men and have more comorbidities but less atherosclerosis. We explored sex differences in revascularization, guideline‐directed medical therapy, and outcomes among patients with chronic coronary disease with ischemia on stress testing, with and without invasive management.Methods and ResultsThe ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial randomized patients with moderate or severe ischemia to invasive management with angiography, revascularization, and guideline‐directed medical therapy, or initial conservative management with guideline‐directed medical therapy alone. We evaluated the primary outcome (cardiovascular death, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) and other end points, by sex, in 1168 (22.6%) women and 4011 (77.4%) men. Invasive group catheterization rates were similar, with less revascularization among women (73.4% of invasive‐assigned women revascularized versus 81.2% of invasive‐assigned men; P<0.001). Women had less coronary artery disease: multivessel in 60.0% of invasive‐assigned women and 74.8% of invasive‐assigned men, and no ≥50% stenosis in 12.3% versus 4.5% (P<0.001). In the conservative group, 4‐year catheterization rates were 26.3% of women versus 25.6% of men (P=0.72). Guideline‐directed medical therapy use was lower among women with fewer risk factor goals attained. There were no sex differences in the primary outcome (adjusted hazard ratio [HR] for women versus men, 0.93 [95% CI, 0.77–1.13]; P=0.47) or the major secondary outcome of cardiovascular death/myocardial infarction (adjusted HR, 0.93 [95% CI, 0.76–1.14]; P=0.49), with no significant sex‐by‐treatment‐group interactions.ConclusionsWomen had less extensive coronary artery disease and, therefore, lower revascularization rates in the invasive group. Despite lower risk factor goal attainment, women with chronic coronary disease experienced similar risk‐adjusted outcomes to men in the ISCHEMIA trial.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- coronary artery disease
- ischemic heart disease
- sex differences
- women's health
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Reynolds, Harmon ...
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Cyr, Derek D.
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Bairey Merz, C. ...
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Shaw, Leslee J.
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Chaitman, Bernar ...
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Boden, William E ...
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show more...
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Alexander, Karen ...
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Rosenberg, Yves ...
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Bangalore, Sripa ...
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Stone, Gregg W.
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Held, Claes, 195 ...
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Spertus, John
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Goetschalckx, Ka ...
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Bockeria, Olga
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Newman, Jonathan ...
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Berger, Jeffrey ...
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Elghamaz, Ahmed
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Lopes, Renato D.
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Min, James K.
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Berman, Daniel S ...
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Picard, Michael ...
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Kwong, Raymond Y ...
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Harrington, Robe ...
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Thomas, Boban
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O'Brien, Sean M.
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Maron, David J.
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Hochman, Judith ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
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Journal of the A ...
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Uppsala University