Is early invasive treatment of unstable coronary artery disease equally effective for both women and men?

BACKGROUND The Fragmin and fast Revascularization during InStability in Cor onary artery disease (FRISC II) trial compared the effectiveness of an earl y invasive versus a noninvasive strategy in terms of the incidence of death and myocardial infarction (MI) in patients with unstable coronary artery d isease (CAD). OBJECTIVES In this subanalysis, we sought to evaluate gender differences in the effect of these different strategies. METHODS The patients (749 women and 1,708 men) were randomized to early inv asive or noninvasive strategies. Coronary angiography was performed within the first 7 days in 96% and 10% of the invasive and noninvasive groups, res pectively, and revascularization was performed within the first 10 days in 71% and 9% of the invasive and noninvasive groups, respectively. RESULTS Women presenting with unstable CAD were older, but fewer had previo us infarctions, left ventricular dysfunction and elevated troponin T levels . Women had fewer angiographic changes. There was no difference in MI or de ath at 12 months among women in the invasive and noninvasive groups (12.4% vs. 10.5%, respectively), in contrast to the favorable effect in the invasi vely treated group of men (9.6% vs. 15.8%, p < 0.001). In an interaction an alysis, there was a different effect of the early invasive strategy for the two genders (p = 0.008). CONCLUSIONS Women with symptoms and/or signs of unstable CAD are older, but still have less severe CAD and a better prognosis compared with men. In co ntrast to its beneficial effect in men, an early invasive strategy did not reduce the risk of future events among women. Further research is warranted to identify the most appropriate treatment strategy in women with unstable CAD. a Am Coil Cardiol 2001;38:41-8) (C) 2001 by the American College of C ardiology.