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Acute Coronary Syndromes
2.9%, adjusted OR 3.6, 95% CI 1.6–8.3; p=0.001). Data from OASIS 5 strategies according to gender and the importance of differences in
WCS, in which eight of 11 major bleedings during follow-up occurred underlying pathophysiology and co-morbidity and effect with a
in the 80 patients treated with PCI compared with one major bleed certain treatment strategy are strongly needed to identify the most
among 78 patients treated conservatively, also indicate a high risk of appropriate treatment for men and women, respectively.
bleeding associated with PCI. Increased bleeding rates have been
reported in ACS patients treated with GPIIb/IIIa inhibitors, especially in A challenge for future research will be to find ways to identify
combination with thienopyridines
25
and among women.
26
Several patients with the highest net clinical benefit from an early invasive
recent trials have highlighted bleeding as an important predictor of strategy, maybe by a multimarker approach as suggested in a sub-
both short- and long-term outcome in patients with ACS.
27–29
study of the TACTICS-TIMI 18
30
or, preferably, by novel markers that
are more specific in identifying plaque rupture. Research efforts
Conclusion and Clinical Implications should also be directed at identifying predictors of complications and
A female population compared with a male population with NSTE-ACS development of invasive techniques to minimise complications. The
appears to receive less benefit from a routine invasive strategy. The clinical challenge is to identify individual patients with the highest
reason is most likely a combination of several factors, among them risk of ischaemic events without unreasonably elevated early risk of
the difference between the genders in risk profile and differences in complications with an invasive strategy. For example, actions to
risk associated with invasive procedures. Both men and women at minimise bleeding complications, including dose adjustments
high risk, defined as elevated markers of myocardial necrosis, seem according to renal function, weight and age, are of utmost
to benefit from an invasive strategy. In low-risk patients with ACS importance for both genders but particularly for women. However, an
there has been an indication of harm with a routine invasive strategy individually tailored treatment strategy to balance early procedural
in women that could not be seen in men. Prospective studies to risk with long-term reduction of cardiac events will benefit both men
elucidate whether there are true differences in the effects of different and women with NSTE-ACS. ■
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84 EUROPEAN CARDIOLOGY
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