title: Invasive versus conservative strategy in acute coronary syndromes: The paradox in women's outcomes.
abstract: BACKGROUND
  We explored benefits and risks of an early invasive compared with a conservative strategy in women versus men after non-ST elevation acute coronary syndromes (NSTE-ACS) using the ISACS-TC database.
  
  
  METHODS
  From October 2010 to May 2014, 4145 patients were diagnosed as having a NSTE-ACS. We excluded 258 patients managed with coronary bypass surgery. Of the remaining 3887 patients, 1737 underwent PCI (26% women). The primary endpoint was the composite of 30-day mortality and severe left ventricular dysfunction defined as an ejection fraction <40% at discharge.
  
  
  RESULTS
  Women were older and more likely to exhibit more risk factors and Killip Class ≥2 at admission as compared with men. In patients who underwent PCI, peri-procedural myocardial injury was not different among sexes (3.1% vs. 3.2%). Women undergoing PCI experienced higher rates of the composite endpoint (8.9% vs. 4.9%, p=0.002) and 30-day mortality (4.4% vs. 2.0%, p=0.008) compared with men, whereas those who managed with only routine medical therapy (RMT) did not show any sex difference in outcomes. In multivariable analysis, female sex was associated with favorable outcomes (adjusted HR for the composite endpoint: 0.72, 95% CI: 0.58-0.91) in patients managed with RMT, but not in those undergoing PCI (adjusted HR: 0.96, 95% CI: 0.61-1.52).
  
  
  CONCLUSIONS
  We observed a more favorable outcome in women than men when patients were managed with RMT. Women and men undergoing PCI have similar outcomes. These data suggest caution in extrapolating the results from men to women in an overall population of patients in the context of different therapeutic strategies.
authors: Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy.
authors: Edina
authors: E
authors: Cenko
authors: Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy.
authors: Beatrice
authors: B
authors: Ricci
authors: University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia.
authors: Sasko
authors: S
authors: Kedev
authors: Clinical Center of Serbia, Medical Faculty, University of Belgrade, Belgrade, Serbia.
authors: Zorana
authors: Z
authors: Vasiljevic
authors: University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania; Department of Cardiology and Internal Medicine, Floreasca Emergency Hospital, Bucharest, Romania.
authors: Maria
authors: M
authors: Dorobantu
authors: Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors: Olivija
authors: O
authors: Gustiene
authors: Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro.
authors: Božidarka
authors: B
authors: Knežević
authors: Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia.
authors: Davor
authors: D
authors: Miličić
authors: Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors: Mirza
authors: M
authors: Dilic
authors: Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy.
authors: Olivia
authors: O
authors: Manfrini
authors: Institute of Natural Sciences, University of Physical Education, Budapest H-1123, Hungary; Department of Physiology, New York Medical College, Valhalla, NY 10595, USA.
authors: Akos
authors: A
authors: Koller
authors: Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
authors: Lina
authors: L
authors: Badimon
authors: Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy. Electronic address: raffaele.bugiardini@unibo.it.
authors: Raffaele
authors: R
authors: Bugiardini
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D017023:Coronary Angiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: Non ST elevation acute coronary syndromes; Outcomes; Percutaneous intervention; Sex differences