ISCHEMIA Outcomes: Does Sex Have Any Impact?

We are well aware of CAD physiopathological disparities and how it manifests differently in men and women. The ISCHEMIA study (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) has revealed that during 3.2 years no differences were seen in the incidence of ischemic events when comparing an invasive strategy (INV) vs a conservative one (CON). However, outcomes by sex are yet to be reported.

Subutilización del tratamiento médico en enfermedad vascular periférica

The aim of this post hoc analysis of the ISCHEMIA (multicenter and randomized) was to compare) the association between participant sex and the likelihood of undergoing revascularization for participants randomized to the INV group; the risk of primary end point by strategy (INV vs CON) and participant sex; and the contribution of the individual primary point components by participant sex.

The primary end point was a composite of cardiovascular death, acute MI, hospitalization for unstable angina, cardiac failure or reanimated cardiac arrest.

Of 5,179 patients, 22.6% were women. Women were older and presented higher prevalence of hypertension and diabetes. Female sex was independently associated with lower revascularization likelihood for INV participants (OR 0.75, CI 95%: 0.57-0.99; p=0.04).

As regards the primary outcome in INV vs CON groups, it resulted similar for both sexes (women: HR 0.96, 95% CI: 0.70-1.33; men: HR 0.90, 95% CI: 0.76-1.07; p for interaction = 0.71). The primary end point individual components showed similarities between sexes, except for periprocedural MI, which resulted significantly lower in women (5.9%) vs men (12.9%) (p=0.01).

Conclusion

The ISCHEMIA showed women presented lower rates of revascularization when assigned to INV. The similarity as regards cardiac outcomes between INV and CON was confirmed both in men and women. However, women experienced lower incidence of periprocedural MI vs men.