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Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease: Insights From the ISCHEMIA Trial

Reynolds, Harmony R ; Cyr, Derek D ; Merz, C Noel Bairey ; Shaw, Leslee J ; Chaitman, Bernard R ; Boden, William E ; Alexander, Karen P ; Rosenberg, Yves D ; Bangalore, Sripal ; Stone, Gregg W ; Held, Claes ; Spertus, John ; Goetschalckx, Kaatje ; Bockeria, Olga ; Newman, Jonathan D ; Berger, Jeffrey S ; Elghamaz, Ahmed ; Lopes, Renato D ; Min, James K ; Berman, Daniel S ; Picard, Michael H ; Kwong, Raymond Y ; Harrington, Robert A ; Thomas, Boban ; O'Brien, Sean M ; Maron, David J ; Hochman, Judith S

Journal of the American Heart Association, 2024-03, Vol.13 (5), p.e029850-e029850 [Periódico revisado por pares]

England: John Wiley and Sons Inc

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Título:
Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease: Insights From the ISCHEMIA Trial
Autor: Reynolds, Harmony R ; Cyr, Derek D ; Merz, C Noel Bairey ; Shaw, Leslee J ; Chaitman, Bernard R ; Boden, William E ; Alexander, Karen P ; Rosenberg, Yves D ; Bangalore, Sripal ; Stone, Gregg W ; Held, Claes ; Spertus, John ; Goetschalckx, Kaatje ; Bockeria, Olga ; Newman, Jonathan D ; Berger, Jeffrey S ; Elghamaz, Ahmed ; Lopes, Renato D ; Min, James K ; Berman, Daniel S ; Picard, Michael H ; Kwong, Raymond Y ; Harrington, Robert A ; Thomas, Boban ; O'Brien, Sean M ; Maron, David J ; Hochman, Judith S
Assuntos: Chronic Disease ; coronary artery disease ; Coronary Artery Disease - complications ; Coronary Artery Disease - therapy ; Female ; Goals ; Humans ; ischemic heart disease ; JAHA Spotlight: Go Red for Women ; Male ; Myocardial Infarction - therapy ; Myocardial Ischemia - complications ; Myocardial Ischemia - therapy ; Original Research ; Sex Characteristics ; sex differences ; Treatment Outcome ; women's health
É parte de: Journal of the American Heart Association, 2024-03, Vol.13 (5), p.e029850-e029850
Notas: ObjectType-Article-1
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A complete list of the ISCHEMIA Research Group members can be found in the Appendix at the end of the article.
This article was sent to Saket Girotra, MD, SM, Associate Editor, for review by expert referees, editorial decision, and final disposition.
Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/JAHA.122.029850
For Sources of Funding and Disclosures, see page 45.
Descrição: Women with chronic coronary disease are generally older than men and have more comorbidities but less atherosclerosis. We explored sex differences in revascularization, guideline-directed medical therapy, and outcomes among patients with chronic coronary disease with ischemia on stress testing, with and without invasive management. The ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial randomized patients with moderate or severe ischemia to invasive management with angiography, revascularization, and guideline-directed medical therapy, or initial conservative management with guideline-directed medical therapy alone. We evaluated the primary outcome (cardiovascular death, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) and other end points, by sex, in 1168 (22.6%) women and 4011 (77.4%) men. Invasive group catheterization rates were similar, with less revascularization among women (73.4% of invasive-assigned women revascularized versus 81.2% of invasive-assigned men; <0.001). Women had less coronary artery disease: multivessel in 60.0% of invasive-assigned women and 74.8% of invasive-assigned men, and no ≥50% stenosis in 12.3% versus 4.5% ( <0.001). In the conservative group, 4-year catheterization rates were 26.3% of women versus 25.6% of men ( =0.72). Guideline-directed medical therapy use was lower among women with fewer risk factor goals attained. There were no sex differences in the primary outcome (adjusted hazard ratio [HR] for women versus men, 0.93 [95% CI, 0.77-1.13]; =0.47) or the major secondary outcome of cardiovascular death/myocardial infarction (adjusted HR, 0.93 [95% CI, 0.76-1.14]; =0.49), with no significant sex-by-treatment-group interactions. Women had less extensive coronary artery disease and, therefore, lower revascularization rates in the invasive group. Despite lower risk factor goal attainment, women with chronic coronary disease experienced similar risk-adjusted outcomes to men in the ISCHEMIA trial. URL: http://wwwclinicaltrials.gov. Unique identifier: NCT01471522.
Editor: England: John Wiley and Sons Inc
Idioma: Inglês

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Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease: Insights From the ISCHEMIA Trial

England: John Wiley and Sons Inc

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