Early Versus Delayed Invasive Management of Female Patients With Non-ST-Elevation Acute Coronary Syndrome: An
Gregory B Mills1,2, Christos P Kotanidis1,2, Shamir Mehta3
1Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, United Kingdom (G.B.M., C.P.K., V.K.).
Circulation. Cardiovascular Interventions
|March 4, 2025
Summary
Early invasive management for female patients with non-ST-elevation acute coronary syndrome did not significantly reduce major adverse events overall. However, high-risk women benefited from early angiography, showing reduced mortality or myocardial infarction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Female patients with non-ST-elevation acute coronary syndrome face higher risks of adverse events.
- They are less likely to receive guideline-recommended coronary angiography and revascularization.
- Optimal timing for angiography in this demographic remains unclear.
Purpose of the Study:
- To evaluate the impact of early versus delayed coronary angiography timing on outcomes in female patients with non-ST-elevation acute coronary syndrome.
- To identify specific subgroups of female patients who may benefit from early invasive management.
Main Methods:
- A systematic search of Medline, Web of Science, and Scopus databases was conducted.
- Individual patient data from six randomized controlled trials were meta-analyzed.
- The primary endpoint was a composite of all-cause mortality or myocardial infarction at 6 months.
Main Results:
- No significant reduction in the primary endpoint was observed with early invasive management compared to delayed management (HR 0.79; P=0.12).
- Early invasive management was associated with a reduction in recurrent ischemia (HR 0.60; P=0.025).
- High-risk female patients (GRACE score >140) and those with elevated cardiac biomarkers showed significantly reduced mortality or myocardial infarction with early management (P=0.021).
Conclusions:
- Early invasive management in female patients with non-ST-elevation acute coronary syndrome does not significantly reduce the primary composite endpoint.
- High-risk female patients, identified by GRACE score or elevated biomarkers, experience significant benefits from early invasive management.
Keywords:
acute coronary syndromecoronary angiographymyocardial infarctionpercutaneous coronary interventionwomenMore Related Videos
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