Time-Dependent Impact of Sex on the Long-Term Outcomes After Left Main Revascularization
Yong-Hoon Yoon1, Jung-Min Ahn2, Jung Bok Lee3
1Department of Cardiology Chungnam National University Sejong HospitalChungnam National University School of Medicine Sejong Korea.
Insights
Long-term outcomes after left main coronary artery revascularization differ by sex. Women experienced a time-dependent impact of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG), unlike men.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Limited data exist on sex-specific long-term outcomes following left main coronary artery disease (LMCD) revascularization.
- Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are primary treatments for LMCD.
- The MAIN-COMPARE registry provides extended follow-up data on these interventions.
Purpose of the Study:
- To evaluate the differential long-term effects of sex on clinical outcomes after PCI versus CABG for unprotected left main coronary artery disease.
- To analyze time-dependent differences in outcomes between PCI and CABG, stratified by sex.
Main Methods:
- Extended follow-up analysis of the MAIN-COMPARE registry, including 2240 patients with unprotected LMCD (1102 PCI, 1138 CABG).
- Outcomes assessed included all-cause mortality, a composite of death, Q-wave myocardial infarction, or stroke, and target vessel revascularization.
- Outcomes were evaluated separately for women (n=631) and men (n=1609), with adjusted analyses considering time-dependent effects.
Main Results:
- Women showed lower 10-year incidences of death and serious composite outcomes compared to men.
- In women, PCI demonstrated a lower risk for serious composite outcomes short-term (0-1 year) but higher risks for death and composite outcomes mid-term (1-5 years) compared to CABG.
- Beyond 5 years, adjusted risks for adverse outcomes were similar between PCI and CABG in women. In men, adjusted 10-year risks were similar across treatment groups.
Conclusions:
- A significant time-dependent interaction between sex and revascularization strategy (PCI vs. CABG) impacts long-term outcomes in LMCD patients.
- The observed differences are particularly notable in women, with distinct short-term and mid-term risk profiles.
- Further validation in larger studies is warranted to confirm these sex-specific, time-dependent findings.
Abstract:
Background There are still limited data about the differential effect of sex on long-term outcomes after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for left main coronary artery disease. This extended follow-up study of the MAIN-COMPARE (Ten-Year Outcomes of Stents Versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease) registry evaluated clinical outcomes beyond 10 years. Methods and Results Of 2240 patients with unprotected left main coronary artery disease (PCI=1102 and CABG=1138), all-cause mortality, the composite of death, Q-wave myocardial infarction, or stroke, and target vessel revascularization were separately evaluated in both sexes. Of 2240 patients, 631 (28.2%) were women and 1609 (71.8%) were men. Women had lower 10-year incidences of death and serious composite outcomes than men. The adjusted 10-year risks of adverse outcomes were similar in men. However, the adjusted 10-year risks were different according to a prespecified period in women. In the short-term (0-1 year) period, PCI had a significantly lower risk for serious composite outcomes (adjusted hazard ratio [HR], 0.41; 95% CI, 0.19-0.91; P=0.03) compared with CABG. The adjusted risks for death and serious composite outcomes were significantly higher after PCI than after CABG, during the midterm (1-5 years) period (death; adjusted HR, 3.99; 95% CI, 2.01-7.92; P<0.001 and composite outcome; adjusted HR, 2.93; 95% CI, 1.59-5.39; P=0.001). Beyond 5 years, adjusted risks were similar after PCI and CABG in women. Conclusions In this 10-year extended follow-up study of patients undergoing left main coronary artery revascularization, we observed a time-dependent impact of sex on the long-term outcomes after PCI and CABG, especially in women, with significant interactions. However, these results warrant confirmation on larger series of studies. Registration URl: https://www.clinicaltrials.gov; Unique identifier: NCT02791412.
More Related Videos
14:35Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
09:12Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...