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Interaction Between Treatment and Age or Sex in Non-ST-Segment Elevation Acute Coronary Disease and Three-Vessel

Tianyu Li1, Lin Jiang2, Lianjun Xu2

  • 1National Clinical Research Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Frontiers in Cardiovascular Medicine
|June 20, 2022
PubMed

Insights

Coronary artery bypass grafting (CABG) offers benefits over percutaneous coronary intervention (PCI) for most patients with three-vessel disease (TVD) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). However, this advantage diminishes in older adults and women, with PCI showing superiority in women aged 75 and above.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Cardiology

Background:

  • Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with three-vessel disease (TVD) requires careful treatment selection.
  • Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are primary revascularization strategies.
  • The influence of age and sex on treatment outcomes in these patients remains an area for detailed investigation.

Purpose of the Study:

  • To investigate the impact of age and sex on the comparative effectiveness of CABG versus PCI in NSTE-ACS patients with TVD.

Main Methods:

  • Subanalysis of a prospective cohort of 2,819 NSTE-ACS patients with TVD.
  • Comparison of major adverse cardiac and cerebrovascular events (MACCEs) between CABG and PCI groups.
  • Assessment of treatment-by-age and treatment-by-sex interactions.

Main Results:

  • The benefit of CABG over PCI in reducing MACCEs decreased with advancing age and was not significant in patients aged 75 years and older.
  • The superiority of CABG was observed in men but not in women, with a trend towards PCI superiority in women.
  • Significant interactions between treatment and sex, and treatment and age were detected.

Conclusions:

  • CABG is generally favored over PCI for NSTE-ACS patients with TVD.
  • The advantage of CABG diminishes in elderly patients (≥75 years) and women.
  • PCI may be a superior option for women aged 75 years and older with NSTE-ACS and TVD.
Abstract

Keywords:
agecoronary artery bypass graftingnon-ST-segment elevation acute coronary syndromepercutaneous coronary interventionsexthree-vessel disease

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