Is there a gender paradox in the early invasive strategy for non ST-segment elevation acute coronary syndromes?
| Autor: | William E. Boden, Rachid A. Elkoustaf |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
medicine.medical_specialty
Unstable angina business.industry medicine.medical_treatment Standard treatment Percutaneous coronary intervention medicine.disease Surgery Coronary artery disease Pharmacotherapy Internal medicine Conventional PCI Cardiology medicine Myocardial infarction Cardiology and Cardiovascular Medicine business Depression (differential diagnoses) |
| Zdroj: | European Heart Journal. 25:1559-1561 |
| ISSN: | 0195-668X |
| Popis: | This editorial refers to "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". † by T.C. Clayton on page 1641 Coronary artery disease and, in particular, acute coronary syndromes (ACS), is the leading cause of mortality and morbidity in industrialised nations.1 While major advances in the diagnosis and treatment of ACS, both in terms of pharmacotherapy and catheter-based revascularisation, have resulted in a continuing, steady decrease in coronary heart disease (CHD) mortality over the last decade among men, the cardiovascular event rate among women has either levelled off or increased – especially in older age groups and among various ethnic minorities.2–4 One of these advances, percutaneous coronary intervention (PCI), has become a standard treatment option for many patients – both men and women – with CHD, and has become increasingly widespread in North America and Europe as the dominant management strategy in patients who present with ACS. Among ACS patients who exhibit ST-segment elevation myocardial infarction (STEMI), the benefits associated with primary PCI are unquestioned, with significant improvements in survival and myocardial salvage as a consequence of the more rapid and complete restoration of antegrade coronary flow through an infarct artery. However, for patients who present with non-ST-segment elevation (NSTE) ACS, the overall benefits associated with an early interventional strategy are more heterogeneous, with clear benefits apparent in high-risk ACS patients, particularly those with biomarker positivity and/or ST-segment depression, and a more neutral effect, compared to a non-invasive, or "ischaemia-guided" management approach, in low-risk patients.5 Even among intermediate- and high-risk ACS patients, however, there is controversy regarding the putative benefits of the early invasive strategy in women, compared … *Correspondence to: William E. Boden, MD, Division of Cardiology, Department of Medicine, The Henry Low Heart Center at Hartford Hospital, Room JB-722, 80 Seymour Street, Hartford, CT, USA (E-mail: wboden{at}harthosp.org). |
| Databáze: | OpenAIRE |
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