title: Is early invasive treatment of unstable coronary artery disease equally effective for both women and men? FRISC II Study Group Investigators.
abstract: BACKGROUND
  The Fragmin and fast Revascularization during InStability in Coronary artery disease (FRISC II) trial compared the effectiveness of an early invasive versus a noninvasive strategy in terms of the incidence of death and myocardial infarction (MI) in patients with unstable coronary artery disease (CAD).
  
  
  OBJECTIVE
  In this subanalysis, we sought to evaluate gender differences in the effect of these different strategies.
  
  
  METHODS
  The patients (749 women and 1,708 men) were randomized to early invasive or noninvasive strategies. Coronary angiography was performed within the first 7 days in 96% and 10% of the invasive and noninvasive groups, respectively, and revascularization was performed within the first 10 days in 71% and 9% of the invasive and noninvasive groups, respectively.
  
  
  RESULTS
  Women presenting with unstable CAD were older, but fewer had previous infarctions, left ventricular dysfunction and elevated troponin T levels. Women had fewer angiographic changes. There was no difference in MI or death at 12 months among women in the invasive and noninvasive groups (12.4% vs. 10.5%, respectively), in contrast to the favorable effect in the invasively treated group of men (9.6% vs. 15.8%, p < 0.001). In an interaction analysis, there was a different effect of the early invasive strategy for the two genders (p = 0.008).
  
  
  CONCLUSIONS
  Women with symptoms and/or signs of unstable CAD are older, but still have less severe CAD and a better prognosis compared with men. In contrast to its beneficial effect in men, an early invasive strategy did not reduce the risk of future events among women. Further research is warranted to identify the most appropriate treatment strategy in women with unstable CAD.
authors.affiliation: Department of Cardiology, University Hospital, Uppsala, Sweden. bo.lagerqvist@card.uas.lul.se
authors.forename: B
authors.initials: B
authors.lastname: Lagerqvist
authors.forename: K
authors.initials: K
authors.lastname: Säfström
authors.forename: E
authors.initials: E
authors.lastname: Ståhle
authors.forename: L
authors.initials: L
authors.lastname: Wallentin
authors.forename: E
authors.initials: E
authors.lastname: Swahn
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D017985:Dalteparin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
chemical_list: D020107:Troponin T; D017985:Dalteparin