Early invasive strategy reduced 30-day mortality in older women (RR 0.57), older men (RR 0.52), and younger men (RR 0.46), but not in younger women (RR 2.27; 95% CI 0.73-7.04).
Observational (n=7,589)
Yes
Does an early invasive strategy reduce 30-day mortality compared to a conservative strategy in stable NSTE-ACS patients, and does this effect vary by age and sex?
An early invasive strategy improves 30-day survival in older women and all men presenting with stable NSTE-ACS, but does not appear to confer a survival advantage in younger women.
Abstract Purpose Previous works have struggled to clearly define sex-specific outcomes based on initial management in NSTE-ACS patients. We examined if early revascularization (24 hours) versus conservative strategy impacts differently based on sex and age in stable NSTE-ACS patients upon hospital admission. Methods We identified 8,920 patients with diagnosis of non-ST elevation acute coronary syndromes (NSTE-ACS) in the ISACS-TC database. Patients with cardiac arrest, hemodynamic instability, and serious ventricular arrhythmias were excluded. The final cohort consisted of 7,589 patients. The characteristics between groups were adjusted using inverse probability of treatment weighting models. Primary outcome measure was all-cause 30-day mortality. Risk ratios (RRs) with their 95% CIs were employed. Results Of the 7,589 NSTE-ACS patients identified, 2,450 (32.3%) were women. The data show a notable reduction in mortality for the elderly women (aged 65 years and older) undergoing early invasive strategy compared to those receiving an initial conservative (3.0% vs. 5.1%; RR: 0.57; 95% CI: 0.32 – 0.99) Conversely, younger women did not exhibit a significant association between early invasive strategy and mortality reduction (2.0% vs. 0.9%; RR: 2.27; 95% CI: 0.73 – 7.04). For men, age stratification did not markedly alter the observed benefits of an early invasive strategy over a conservative approach in the overall population, with reduced death rates in both older (3.1% vs. 5.7%; RR: 0.52; 95% CI: 0.34 – 0.80) and younger age groups (0.8% vs. 1.7%; RR: 0.46; 95% CI: 0.22 – 0.94). These age and sex-specific mortality patterns did not significantly change within subgroups stratified by the presence of NSTEMI, or a GRACE risk score140. Conclusion Early coronary revascularization is associated with improved 30-day survival in older men and women and younger men who present to hospital in stable conditions after NSTE-ACS. It does not confer a survival advantage in young women. Further studies are needed to more accurately risk stratify young women to guide treatment strategies.
Cenko et al. (Sat,) conducted a observational in stable NSTE-ACS (n=7,589). Early invasive strategy (<24 hours) vs. Conservative strategy was evaluated on all-cause 30-day mortality. Early invasive strategy reduced 30-day mortality in older women (RR 0.57), older men (RR 0.52), and younger men (RR 0.46), but not in younger women (RR 2.27; 95% CI 0.73-7.04).