This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (53)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Revascularization  • Cardiovascular System  • Radiologic Imaging  • Surgery  • Surgical Interventions  • Cardiovascular/ Cardiothoracic Surgery  • Women's Health  • Women's Health, Other  • Angiology  • Cardiovascular Disease/ Myocardial Infarction  • Cardiovascular Intervention  • Alert me on articles by topic  Social Bookmarking   What's this?

Ruchira Glaser, MD; Howard C. Herrmann, MD; Sabina A. Murphy, MPH; Laura A. Demopoulos, MD; Peter M. DiBattiste, MD; Christopher P. Cannon, MD; Eugene Braunwald, MD

JAMA. 2002;288:3124-3129.

Context  Women who present with acute coronary syndromes (ACSs) have different characteristics than men. Reports have conflicted about whether different outcomes exist for women with use of a routine invasive management strategy. However, these studies were performed prior to the widespread use of platelet glycoprotein IIb/IIIa inhibitors and intracoronary stents.

Objective  To determine sex differences in baseline characteristics and outcomes in ACS and whether women benefit from a contemporary early invasive management strategy.

Design and Setting  Prospective analysis of women and men enrolled in the TACTICS-TIMI 18 randomized trial, conducted December 1997 to December 1999 in 169 centers in 9 countries in North America and Europe, with follow-up at 1 and 6 months.

Participants  A total of 2220 patients (757 women and 1463 men) with ACS.

Interventions  All patients received aspirin, 325 mg/d; intravenous unfractionated heparin; and tirofiban for 48 hours or until revascularization, with tirofiban administered for at least 12 hours after percutaneous coronary revascularization. Patients assigned to the early invasive strategy (n = 1114) underwent coronary angiography 4 to 48 hours after randomization and revascularization when appropriate. Patients assigned to the early conservative strategy (n = 1106) were treated medically and underwent coronary angiography and appropriate revascularization only if they met specified criteria.

Main Outcome Measures  Baseline characteristics and the primary composite end point of death, myocardial infarction, or rehospitalization for ACS at 6 months in women and men assigned to early invasive vs conservative management.

Results  Women were older and more frequently had hypertension (P<.001 for both). Women less frequently had previous myocardial infarction, coronary artery bypass grafting, and elevations in cardiac markers (P<.001 for all), but there was no difference in distribution of TIMI risk scores (P = .76). Angiography and intervention rates were similar, but women had less severe coronary artery disease, including no critical lesions in 17% of women vs 9% of men (P<.001). Women had a 28% odds reduction in the primary end point with an early invasive strategy (adjusted odds ratio [OR], 0.72; 95% confidence interval [CI], 0.47-1.11), similar to the benefit in men (adjusted OR, 0.64; 95% CI, 0.47-0.88; P = .60 for sex interaction). When adjusted for baseline characteristics, the benefit of invasive therapy in women with elevated troponin T levels was further enhanced (adjusted OR, 0.47; 95% CI, 0.26-0.83).

Conclusions  Despite differences between women and men in baseline characteristics, the benefit of an early invasive strategy incorporating tirofiban and intracoronary stents was similar in women and men and was enhanced in women presenting with markers of increased risk.

Author Affiliations: Department of Medicine, University of Pennsylvania, Philadelphia (Drs Glaser and Herrmann); Department of Medicine, Brigham and Women's Hospital, Boston, Mass (Ms Murphy, and Drs Cannon and Braunwald); and Merck Research Laboratories, Blue Bell, Pa (Drs Demopoulos and DiBattiste).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLES

Acute Coronary Syndromes: Does Sex Matter?
Judith S. Hochman and Jacqueline E. Tamis-Holland
JAMA. 2002;288(24):3161-3164.
EXTRACT | FULL TEXT  

Heart Disease and Women
JAMA. 2002;288(24):3230.
PDF  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Adverse Cardiovascular Outcomes in Women With Nonobstructive Coronary Artery Disease: A Report From the Women's Ischemia Syndrome Evaluation Study and the St James Women Take Heart Project
Gulati et al.
Arch Intern Med 2009;169:843-850.
ABSTRACT | FULL TEXT  

Use of Guidelines-Recommended Management and Outcomes Among Women and Men With Low-Level Troponin Elevation: Insights From CRUSADE
Halim et al.
Circ Cardiovasc Qual Outcomes 2009;2:199-206.
ABSTRACT | FULL TEXT  

Status of Women in Cardiovascular Clinical Trials
Kim and Menon
Arterioscler. Thromb. Vasc. Bio. 2009;29:279-283.
FULL TEXT  

Early invasive compared with a selective invasive strategy in women with non-ST-elevation acute coronary syndromes: a substudy of the OASIS 5 trial and a meta-analysis of previous randomized trials
Swahn et al.
Eur Heart J 2009;0:ehp009v1-10.
ABSTRACT | FULL TEXT  

Coronary Intervention in 2009: Are Women No Different Than Men?
Jacobs
Circ Cardiovasc Intervent 2009;2:69-78.
FULL TEXT  

Early Invasive vs Conservative Treatment Strategies in Women and Men With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-analysis
O'Donoghue et al.
JAMA 2008;300:71-80.
ABSTRACT | FULL TEXT  

Gender differences in management and outcomes in patients with acute coronary syndromes: results on 20 290 patients from the AMIS Plus Registry
Radovanovic et al.
Heart 2007;93:1369-1375.
ABSTRACT | FULL TEXT  

Gender differences in management and outcome in non-ST-elevation acute coronary syndrome
Alfredsson et al.
Heart 2007;93:1357-1362.
ABSTRACT | FULL TEXT  

64-Slice CT coronary angiography in patients with non-ST elevation acute coronary syndrome
Meijboom et al.
Heart 2007;93:1386-1392.
ABSTRACT | FULL TEXT  

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
Anderson et al.
J Am Coll Cardiol 2007;50:e1-e157.
FULL TEXT  

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
Anderson et al.
J Am Coll Cardiol 2007;50:652-726.
FULL TEXT  

Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology
Authors/Task Force Members et al.
Eur Heart J 2007;28:1598-1660.
FULL TEXT  

Triggering of acute coronary syndromes by physical exertion and anger: clinical and sociodemographic characteristics
Strike et al.
Heart 2006;92:1035-1040.
ABSTRACT | FULL TEXT  

Coronary revascularisation in women
Mikhail
Heart 2006;92:iii19-iii23.
ABSTRACT | FULL TEXT  

Cardiovascular diseases in women: a statement from the policy conference of the European Society of Cardiology
Stramba-Badiale et al.
Eur Heart J 2006;27:994-1005.
ABSTRACT | FULL TEXT  

Women, Ischemic Heart Disease, Revascularization, and the Gender Gap: What Are We Missing?
Jacobs
J Am Coll Cardiol 2006;47:S63-S65.
ABSTRACT | FULL TEXT  

Gender Differences in Outcomes After Hospital Discharge From Coronary Artery Bypass Grafting
Guru et al.
Circulation 2006;113:507-516.
ABSTRACT | FULL TEXT  

Differences in the Management and Prognosis of Women and Men Who Suffer From Acute Coronary Syndromes
Anand et al.
J Am Coll Cardiol 2005;46:1845-1851.
ABSTRACT | FULL TEXT  

Prospects for Personalized Cardiovascular Medicine: The Impact of Genomics
Ginsburg et al.
J Am Coll Cardiol 2005;46:1615-1627.
ABSTRACT | FULL TEXT  

Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: Large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative
Blomkalns et al.
J Am Coll Cardiol 2005;45:832-837.
ABSTRACT | FULL TEXT  

Revascularization for everyone?
Redberg
Eur Heart J 2005;26:525-525.
FULL TEXT  

Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women: A Statement for Healthcare Professionals From the American Heart Association
Lansky et al.
Circulation 2005;111:940-953.
ABSTRACT | FULL TEXT  

Angina With "Normal" Coronary Arteries: A Changing Philosophy
Bugiardini and Bairey Merz
JAMA 2005;293:477-484.
ABSTRACT | FULL TEXT  

Is there a gender paradox in the early invasive strategy for non ST-segment elevation acute coronary syndromes?
Elkoustaf and Boden
Eur Heart J 2004;25:1559-1561.
FULL TEXT  

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
Clayton et al.
Eur Heart J 2004;25:1641-1650.
ABSTRACT | FULL TEXT  

Update in Women's Health
Carnes and Mahoney
ANN INTERN MED 2004;140:538-544.
FULL TEXT  

Acute Coronary Syndrome: The Risk of Being Female
Elsaesser and Hamm
Circulation 2004;109:565-567.
FULL TEXT  

Differential Expression of Cardiac Biomarkers by Gender in Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction 18) Substudy
Wiviott et al.
Circulation 2004;109:580-586.
ABSTRACT | FULL TEXT  

Application of Current Guidelines to the Management of Unstable Angina and Non-ST-Elevation Myocardial Infarction
Braunwald
Circulation 2003;108:III-28-37.
ABSTRACT | FULL TEXT  

ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB
Evid. Based Med. 2003;8:99-99.
FULL TEXT  

More Support for Early Intervention in Women with Acute Coronary Syndrome
JWatch Women's Health 2003;2003:8-8.
FULL TEXT  

Women with High-Risk ACS Benefit from Early Invasive Therapy
Journal Watch Cardiology 2003;2003:5-5.
FULL TEXT  

Acute Coronary Syndromes: Does Sex Matter?
Hochman and Tamis-Holland
JAMA 2002;288:3161-3164.
FULL TEXT