European Heart Journal Advance Access originally published online on February 8, 2005
European Heart Journal 2005 26(5):525; doi:10.1093/eurheartj/ehi120
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Revascularization for everyone?
Director, Women's Cardiovascular Services,
UCSF Division of Cardiology
San Francisco, CA, USA
Tel: +1 415 476 6874
Fax: +1 415 502 8627
E-mail address: redberg{at}medicine.ucsf.edu
I read with interest Chris Cannon's editorial on revascularization in the setting of acute coronary syndrome.1 I was disappointed that Dr Cannon failed to mention that in two of the three major studies of early invasive vs. conservative management for acute coronary syndrome, women not only showed no benefit, but had higher risk of mortality with the early invasive arm. In both FRISC-II2 and RITA-33,4 women in all risk categories were more likely to die if they underwent early invasive therapy for acute coronary syndrome. It is only in TACTICS-TIMI 18 that women at high risk (elevated troponin T) showed a benefit with early invasive therapy.5 Gender differences in results in acute coronary syndrome have also been shown in the use of glycoprotein IIb/IIIa inhibitors.6 Again, while men show a mortality benefit with use of glycoprotein IIb/IIIa inhibitors, women, in a large meta-analysis of over 30 000 patients from six major trials, show a 15% increase in the primary endpoint, death or myocardial infarction, when treated with the glycoprotein IIb/IIIa inhibitors for acute coronary syndrome.7 It was only in the high-risk category (increased troponin) that women showed a non-significant trend towards benefit, with use of glycoprotein IIb/IIIa agents. It is important to consider results for treatment of acute coronary syndromes in men and women separately, as the risks and benefits differ. It is essential to better understand the pathophysiology in both sexes, so that we can optimally treat every patient with acute coronary syndrome.
References
- Cannon CP. Revascularisation for everyone? Eur Heart J 2004;25:1471–1472.
[Free Full Text] - Lagerqvist B, Safstrom K, Stahle E, Wallentin L, Swahn E. Is early invasive treatment of unstable coronary artery disease equally effective for both women and men? FRISC II Study Group Investigators. J Am Coll Cardiol 2001;38:41–48.
[Abstract/Free Full Text] - Fox KA, Poole-Wilson PA, Henderson RA, Clayton TC, Chamberlain DA, Shaw TR, Wheatley DJ, Pocock SJ. Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: the British Heart Foundation RITA 3 randomised trial. Randomized Intervention Trial of unstable Angina. Lancet 2002;360:743–751.[CrossRef][Web of Science][Medline]
- Clayton TC, Pocock SJ, Henderson RA, Poole-Wilson PA, Shaw TR, Knight R, Fox KA. Do men benefit more than women from an interventional strategy in patients with unstable angina or non-ST-elevation myocardial infarction? The impact of gender in the RITA 3 trial. Eur Heart J 2004;25:1641–1650.
[Abstract/Free Full Text] - Glaser R, Herrmann HC, Murphy SA, Demopoulos LA, DiBattiste PM, Cannon CP, Braunwald E. Benefit of an early invasive management strategy in women with acute coronary syndromes. JAMA 2002; 288:3124–3129.
[Abstract/Free Full Text] - Bennett SK, Redberg RF. Acute coronary syndromes in women: is treatment different? Should it be? Curr Cardiol Rep 2004;6:243–252.[Medline]
- Boersma E, Harrington RA, Moliterno DJ, White H, Theroux P, Van de Werf F, de Torbal A, Armstrong PW, Wallentin LC, Wilcox RG, Simes J, Califf RM, Topol EJ, Simoons ML. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes. Lancet 2002;359:189–198.[CrossRef][Web of Science][Medline]
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