Author + information
- Islam Elgendy,
- Ahmed Mahmoud,
- Hend Mansoor and
- Anthony Bavry
Background: Studies have shown improved outcomes with an early invasive strategy in men with non-ST-elevation acute coronary syndrome (NSTE-ACS). In contrast, data have been less conclusive in women, with some trials suggesting potential harm. This study aimed to assess if an early invasive strategy in women is associated with better outcomes in real world data.
Methods: Women admitted with a primary diagnosis of Non-ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA) were identified from the National Inpatient Sample years 2012-2013. The incidence of in-hospital mortality in women with NSTE-ACS undergoing an early invasive strategy (i.e., coronary angiogram +/- percutaneous coronary intervention or coronary artery bypass grafting within 48 hours of admission) versus an initial conservative strategy was compared using a propensity score matched analysis. Propensity scores were calculated using a non-parsimonious multivariable logistic regression model with 53 baseline demographics and clinical characteristics entered as covariates.
Results: Among 372,080 women with NSTE-ACS; 153,680 (41.3%) were managed with an early invasive strategy and 218,400 (58.7%) with an initial conservative strategy. Propensity score matched 19,965 women treated with an early invasive strategy and 20,009 women treated with an initial conservative strategy. The risk of in-hospital mortality was lower with an early invasive strategy (2.1% versus 3.8%; odds ratio [OR] 0.55, 95% confidence interval [CI] 0.49-0.62). This benefit was noted in women presenting with NSTEMI (OR 0.52, 95% CI 0.46-0.58), and was not observed in women with UA (OR 5.14, 95% 0.47-56.9), P for interaction=0.06. A propensity-adjusted analysis yielded similar results (OR 0.51, 95% CI 0.45-0.57).
Conclusions: In this large contemporary observational analysis of women with NSTE-ACS, an early invasive strategy was associated with lower in-hospital mortality. This benefit was observed in women presenting with NSTEMI but not with UA. These findings provide evidence supporting the guideline recommendations for an early invasive strategy in women with NSTE-ACS and high-risk features (e.g. Troponin positive).
Moderated Poster Contributions
Interventional Cardiology Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-9:55 a.m.
Session Title: PCI Strategies and Outcomes Unique to Women
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1214M-03
- 2017 American College of Cardiology Foundation