(July 2, 2008 - Insidermedicine) An invasive strategy is beneficial for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS), except for low-risk women, according to a meta-analysis published in the Journal of the American Medical Association.

According to the European Society of Cardiology, the following should be noted when risk stratifying patients with NSTE ACS:

•    Clinical indicators: age, heart rate, blood pressure, Killip class, diabetes, previous MI/coronary artery disease and risk score result

•    ECG markers: ST-segment depression; imaging findings: low ejection fraction, main stem lesion, three vessel disease

•    Lab markers: troponins, glomerular filtration rate/creatinine clearance/cystatin C, plasma B-type natriuretic peptide/N-terminal prohormone brain natriuretic peptide, high sensitive C-reactive protein

Researchers out of Brigham and Women’s Hospital and Massachusetts General Hospital analyzed data from eight randomized trials exploring the risks and benefits of invasive therapy, consisting of angiography and revascularization, or conservative therapy, consisting of pharmacologic therapy as a primary strategy, for the treatment of NSTE-ACS.

Among both high- and low-risk men, an invasive strategy significantly reduced the risk of the composite endpoint of death, MI, or rehospitalization for unstable angina or MI. This was also the case for high risk women. Among low-risk women there was no reduced risk, and the risk of death or MI was actually increased by a nonsignificant 35%.

Today's research demonstrates how patients in distinct risk categories may respond differently to the same treatment. While men and high-risk women with NSTE ACS appear to benefit from a primary invasive strategy, a more conservative approach may be best for low-risk women.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.