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Prognostic Value of Sex After Revascularization for Left Main Coronary Disease: Extended PRECOMBAT Study

Yujin Yang1, Yeong Jin Jeong1, Junho Hyun1

  • 1Department of Cardiology, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

JACC. Asia
|November 7, 2022
PubMed

Insights

This study found no significant sex differences in long-term outcomes for patients with left main coronary artery disease treated with percutaneous coronary intervention or coronary artery bypass grafting. Both male and female patients experienced similar rates of major adverse cardiac or cerebrovascular events over 10 years.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Female subjects historically exhibit poorer outcomes in left main coronary artery (LMCA) disease compared to males.
  • Limited data exists on the long-term prognostic impact of sex and sex-treatment interactions in LMCA disease patients undergoing revascularization.

Purpose of the Study:

  • To investigate the long-term effects of sex on outcomes after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in LMCA disease.
  • To analyze sex-treatment interactions in LMCA disease management.

Main Methods:

  • The extended PRECOMBAT trial randomized 600 patients with LMCA disease to PCI with drug-eluting stents or CABG.
  • Long-term clinical outcomes, including major adverse cardiac or cerebrovascular events (MACCE), were evaluated over 10 years.

Main Results:

  • Overall 10-year MACCE rates were similar between male (27.3%) and female (27.0%) subjects.
  • No significant difference in MACCE was observed between PCI and CABG for either male or female patients.
  • No significant sex-treatment interaction was found regarding the adjusted risk of MACCE at 10 years (P for interaction = 0.52).

Conclusions:

  • This 10-year follow-up of the PRECOMBAT trial indicates no sex-related impact on long-term MACCE risk after PCI or CABG for LMCA disease.
  • Findings suggest comparable long-term safety and efficacy of PCI versus CABG irrespective of patient sex in LMCA disease.
Abstract

Keywords:
CABG, coronary artery bypass graftingCAD, coronary artery diseaseCI, confidence intervalDES, drug-eluting stentsHR, hazard ratioLMCA, left main coronary arteryMACCE, major adverse cardiac or cerebrovascular eventsMI, myocardial infarctionPCI, percutaneous coronary interventionRCT, randomized controlled trialTVR, target vessel revascularizationcoronary artery bypass surgeryleft main coronary artery diseasemortalitypercutaneous coronary interventionsex

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