Chicago, IL - A retrospective study has shown that women with non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) gain as much benefit from percutaneous coronary intervention as men [1]. Dr Rachid Elkoustaf (Hartford Hospital, CT) reported the findings last week at the Society for Cardiovascular Angiography and Interventions 2006 Scientific Sessions.

Although advances in the diagnosis and treatment of acute coronary syndromes have resulted in a decrease in coronary heart disease mortality over the past decade among men, the death rate among women continues to increase, Elkoustaf explained.

Interventional strategies should not be based on gender.

He told heartwire that previous studies "have yielded conflicting results." For example, in TACTICS-TIMI 18, the benefit of PCI was seen in both men and women, but in two European trials—FRISC II and RITA-3—there was no advantage of an early invasive strategy in women. These inconsistent data have led to controversy about the role that the sex of patients should play in determining risk and in selecting optimal management strategies, he said.

"We decided to look at real-world patients, with the hypothesis that there would not be any difference in nine-month outcomes between men and women. And that is what we found—interventional strategies should not be based on gender."

Elkoustaf and colleagues identified 1524 consecutive patients with NSTE-ACS (488 women and 1036 men) who underwent PCI during their index hospitalization. In-hospital major adverse cardiovascular events (MACE) as well as nine-month follow-up MACE were compared between the sexes.

Women did have a higher incidence of bleeding complications requiring transfusions, Elkoustaf noted (10.9% vs 2.8%; p <0.01), adding that this "correlates with other registry data." This could be because there is an increased ratio of sheath size to body surface area in women and/or to the fact that women often get less accurately weight-adjusted anticoagulation, he reasoned.

There were also clear treatment disparities in adjuvant pharmacotherapy, he said—for example, females received GP IIb/IIIa inhibitors less often than men (65.0% vs 70.2%; p<0.03). And women did exhibit a trend toward a higher rate of myocardial infarction, which is consistent with results from a Dutch randomized controlled trial (ICTUS), Elkoustaf explained.

Nevertheless, overall, there were no statistically significant differences between the sexes in in-hospital or nine-month event-free survival.

"Although limited by its size and the retrospective collection of data, our study has important public-health implications and shows that women should not be denied access to the cath lab, particularly high-risk women," Elkoustaf concluded.