No significant benefit of early invasive treatment in women with High-Risk non ST elevation ACS: Study
Researchers have observed that female patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) are more likely to have adverse outcomes but receive fewer recommended interventions by guidelines like coronary angiography and revascularization. Although early invasive management is good for high-risk patients, very little is known about the optimal timing of angiography in women. A new study was published in the journal CIRCULATION: Cardiovascular Interventions conducted by Gregory B. and fellow researchers.
Systematic search was performed on Medline, Web of Science, and Scopus until November 2023. Randomized controlled trials of early versus delayed coronary angiography in NSTE-ACS patients were included. Individual patient data from 2257 female patients in six trials were analyzed. Patients were divided into two groups:
• Early invasive group (n=1141) with a median time to angiography of 5 hours.
• Delayed invasive group (n=1116) with median time to angiography of 49 hours.
The main outcome was a composite of all-cause mortality or myocardial infarction at 6 months. One-stage individual patient data meta-analysis was done with random-effects Cox models.
Key Findings
• There was no significant reduction in the main outcome (all-cause mortality or myocardial infarction) between early and delayed groups (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.60–1.06; p=0.12).
• Early invasive treatment greatly lowered the risk of repeated ischemia (HR, 0.60; 95% CI, 0.39–0.94; p=0.025).
• In female patients at high risk and with a Global Registry of Acute Coronary Events (GRACE) score >140, early invasive treatment strongly lowered all-cause mortality or myocardial infarction at 6 months (HR, 0.65; 95% CI, 0.45–0.94; p=0.021; Pinteraction=0.035).
• Similar benefits were seen in female patients with elevated cardiac biomarkers, suggesting that early invasive management is particularly beneficial in high-risk groups.
Early invasive treatment in women with NSTE-ACS did not demonstrate a substantial overall decrease in mortality or myocardial infarction from delayed treatment. High-risk women, especially those with GRACE scores >140 or positive cardiac biomarkers, benefited significantly from early invasive treatment. These results highlight the significance of risk stratification in informing clinical decision-making in women with NSTE-ACS.
Reference:
Mills GB, Kotanidis CP, Mehta S, Tiong D, Badings EA, Engstrøm T, van 't Hof AWJ, Høfsten D, Holmvang L, Jobs A, Køber L, Milasinovic D, Milosevic A, Stankovic G, Thiele H, Mehran R, Kunadian V. Early Versus Delayed Invasive Management of Female Patients With Non-ST-Elevation Acute Coronary Syndrome: An Individual Patient Data Meta-Analysis. Circ Cardiovasc Interv. 2025 Mar 4:e014763. doi: 10.1161/CIRCINTERVENTIONS.124.014763. Epub ahead of print. PMID: 40035144.
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