title: Impact of an invasive strategy on 5 years outcome in men and women with non-ST-segment elevation acute coronary syndromes.
abstract: 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.
authors.affiliation: Department of Cardiology and Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden. Electronic address: joakim.alfredsson@liu.se.
authors.forename: Joakim
authors.initials: J
authors.lastname: Alfredsson
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Clayton
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Damman
authors.affiliation: Cardiovascular Research, Department of Medical and Radiological Sciences, Royal Infirmary, Edinburgh, United Kingdom.
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.affiliation: Department of Cardiology and Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Fredriksson
authors.affiliation: Department of Cardiology, Cardiothoracic Centre, University Hospital, Uppsala, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Lagerqvist
authors.affiliation: Department of Cardiology, Cardiothoracic Centre, University Hospital, Uppsala, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.affiliation: Department of Cardiology and Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Swahn
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000601:surgery*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods*; D016896:Treatment Outcome