Background: There is conflicting evidence regarding the benefit of an early invasive
strategy vs. a conservative strategy in women with non-ST-elevation acute coronary
Methods: We searched English-language studies on MEDLINE and the Cochrane Database
of Systematic Reviews from 2000 to December 2015. Results from major available studies
and meta-analysis comparing outcomes of an early invasive strategy vs. a conservative strategy
or medical therapy vs. revascularization in women with NSTE-ACS were considered.
Results: Available data on the comparative effectiveness and safety of different management
strategies in NSTE-ACS women derive from observational registries and pre-specified gender
sub-analyses of randomized trials comparing early routine invasive with a selective invasive
strategy. While some post-hoc analysis of randomized trials showed that an early invasive
strategy did not reduce the risk of future events among women, in contrast to its beneficial effect in men,
others showed similar benefits of a routine early invasive vs. a conservative strategy in men and women. Several
important differences between these trials may explain the lack of benefits from a routine invasive strategy compared
with a conservative strategy. Overall evidence showed better outcomes with a routine invasive strategy,
especially for women at higher risk and those with positive biomarkers. Differently, women with negative biomarkers
and those at lower risk appeared to benefit most from a conservative approach.
Conclusion: The benefit of an early invasive strategy is restricted to women at higher risk. Further research is
warranted to define the optimal management of women with NSTE-ACS.