Pompei Graziella, Mills Gregory B, Kotanidis Christos P, Mehta Shamir, Tiong Denise, Badings Erik A, Engstrøm Thomas, Van't Hof Arnoud W J, Høfsten Dan, Holmvang Lene, Jobs Alexander, Køber Lars, Milasinovic Dejan, Milosevic Aleksandra, Stankovic Goran, Thiele Holger, Mehran Roxana, Kunadian Vijay
Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy.
Eur Heart J Open. 2025 May 17;5(3):oeaf059. doi: 10.1093/ehjopen/oeaf059. eCollection 2025 May.
Studies investigating the timing of coronary angiography in non-ST-elevation acute coronary syndrome (NSTE-ACS) have not evaluated sex differences. This study aims to investigate the sex-related differences in outcomes of NSTE-ACS patients undergoing early or delayed invasive management.
An individual patient data (IPD) meta-analysis was performed after systematic review of randomized controlled trials (RCTs) comparing early vs. delayed invasive strategy among NSTE-ACS patients. The primary endpoint was a composite of all-cause death or myocardial infarction (MI) at 6 months. Secondary endpoints included all-cause death, MI, recurrent ischaemia, stroke, and major bleeding. One-stage, random-effects Cox models were conducted. This meta-analysis was registered with PROSPERO (CRD42023468604). Six RCTs including 6654 patients were identified, of whom 2257 (33.9%) were females with a median age of 69 years [interquartile range (IQR) 60-76], significantly higher than males (64.5 years, IQR 55-72.1, < 0.001). Among patients undergoing early strategy, there was no sex difference in the occurrence of the primary [Hazard ratio (HR) 1.08, 95% confidence interval (CI) 0.83-1.41, = 0.560] and secondary endpoints. Among patients undergoing delayed strategy, there was no difference in the occurrence of the primary endpoint (HR 1.12, 95% CI 0.88-1.43, = 0.350). Female sex undergoing delayed strategy was associated with higher risk of recurrent ischaemia (HR 1.52, 95% CI 1.06-2.19, = 0.023) and major bleeding (HR 1.88, 95% CI 1.22-2.87, = 0.004) using univariable analysis but not using multivariable analysis.
No sex-related differences in the composite of all-cause death or MI were identified among NSTE-ACS patients undergoing early and delayed invasive management.
研究非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者冠状动脉造影时机的研究尚未评估性别差异。本研究旨在调查接受早期或延迟侵入性治疗的NSTE-ACS患者结局的性别相关差异。
在对比较NSTE-ACS患者早期与延迟侵入性策略的随机对照试验（RCT）进行系统评价后，进行了个体患者数据（IPD）荟萃分析。主要终点是6个月时全因死亡或心肌梗死（MI）的复合终点。次要终点包括全因死亡、MI、复发缺血、中风和大出血。进行了单阶段随机效应Cox模型分析。该荟萃分析已在PROSPERO（CRD42023468604）注册。确定了6项RCT，共6654例患者，其中2257例（33.9%）为女性，中位年龄69岁[四分位间距（IQR）60-76]，显著高于男性（64.5岁，IQR 55-72.1，<0.001）。在接受早期治疗策略的患者中，主要终点[风险比（HR）1.08，95%置信区间（CI）0.83-1.41，P=0.560]和次要终点的发生率无性别差异。在接受延迟治疗策略的患者中，主要终点的发生率无差异（HR 1.12，95%CI 0.88-1.43，P=0.350）。单变量分析显示，接受延迟治疗策略的女性复发缺血风险（HR 1.52，95%CI 1.06-2.19，P=0.023）和大出血风险（HR 1.88，95%CI 1.22-2.87，P=0.004）较高，但多变量分析未显示此差异。
在接受早期和延迟侵入性治疗的NSTE-ACS患者中，未发现全因死亡或MI复合终点存在性别相关差异。
