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.
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