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Outcomes by sex in the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial.
Gaudino, Mario; Alexander, John H; Sandner, Sigrid; Harik, Lamia; Kim, Jessica; Stone, Gregg W; Rahouma, Mohamed; O'Gara, Patrick; Bhatt, Deepak L; Redfors, Bjorn.
Afiliación
  • Gaudino M; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
  • Alexander JH; Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, NC, USA.
  • Sandner S; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
  • Harik L; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
  • Kim J; Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
  • Stone GW; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  • Rahouma M; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
  • O'Gara P; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
  • Bhatt DL; Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  • Redfors B; Department of Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
EuroIntervention ; 20(9): 551-560, 2024 May 10.
Article en En | MEDLINE | ID: mdl-38444364
ABSTRACT

BACKGROUND:

In the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial, among participants with stable coronary artery disease, the risk of cardiac events was similar between an invasive (INV) strategy of angiography and coronary revascularisation and a conservative (CON) strategy of initial medical therapy alone. Outcomes according to participant sex were not reported.

AIMS:

We aimed to analyse the outcomes of ISCHEMIA by participant sex.

METHODS:

We evaluated 1) the association between participant sex and the likelihood of undergoing revascularisation for participants randomised to the INV arm; 2) the risk of the ISCHEMIA primary composite outcome (cardiovascular death, any myocardial infarction [MI] or rehospitalisation for unstable angina, heart failure or resuscitated cardiac arrest) by participant sex; and 3) the contribution of the individual primary outcome components to the composite outcome by participant sex.

RESULTS:

Of 5,179 randomised participants, 1,168 (22.6%) were women. Female sex was independently associated with a lower likelihood of revascularisation when assigned to the INV arm (adjusted odds ratio 0.75, 95% confidence interval [CI] 0.57-0.99; p=0.04). The INV versus CON effect on the primary composite outcome was similar between sexes (women hazard ratio [HR] 0.96, 95% CI 0.70-1.33; men HR 0.90, 95% CI 0.76-1.07; pinteraction=0.71). The contribution of the individual components to the composite outcome was similar between sexes except for procedural MI, which was significantly lower in women (9/151 [5.9%]) than men (67/519 [12.9%]; p=0.01).

CONCLUSIONS:

In ISCHEMIA, women assigned to the INV arm were less likely to undergo revascularisation than men. The effect of an INV versus CON strategy was consistent by sex, but women had a significantly lower contribution of procedural MI to the primary outcome.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: EuroIntervention Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA / TERAPEUTICA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Francia
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: EuroIntervention Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA / TERAPEUTICA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Francia