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Coronary artery bypass surgery versus percutaneous interventions for women with multivessel coronary artery disease

Edward L Hannan1, Yifeng Wu1, Lamia Harik2

  • 1University at Albany, State University of New York, Albany, NY.

The Journal of Thoracic and Cardiovascular Surgery
|December 15, 2023
PubMed

Insights

For women with multivessel coronary artery disease, coronary artery bypass graft surgery shows better long-term outcomes than percutaneous coronary intervention with everolimus-eluting stents, including reduced mortality and repeat procedures.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Multivessel coronary artery disease (CAD) affects many women.
  • Treatment decisions between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery require careful consideration of patient outcomes.
  • Understanding long-term results is crucial for optimizing care in this demographic.

Purpose of the Study:

  • To compare the long-term effectiveness and safety of PCI with everolimus-eluting stents (EES) versus CABG surgery in women with multivessel CAD.
  • To evaluate differences in all-cause mortality, major adverse cardiac events, and repeat revascularization rates between the two treatment strategies.

Main Methods:

  • Retrospective, propensity-score matched cohort study utilizing the New York State cardiac registry (2012-2018).
  • Inclusion of women with multivessel CAD undergoing either PCI with EES or CABG surgery.
  • Primary outcome: all-cause mortality; Secondary outcome: major adverse cardiac events (all-cause mortality, myocardial infarction, stroke).

Main Results:

  • PCI with EES was associated with higher 6-year all-cause mortality (25.75% vs 23.57%) and major adverse cardiac events (36.58% vs 32.89%) compared to CABG.
  • PCI also showed higher rates of myocardial infarction (14.94% vs 9.12%) and repeat revascularization (21.53% vs 11.57%).
  • No significant difference in mortality was observed for PCI in cases of complete revascularization, noncomplex lesions, or in women without diabetes.

Conclusions:

  • For women with multivessel coronary artery disease, CABG surgery demonstrates superior long-term outcomes compared to PCI with EES.
  • CABG is associated with reduced 6-year mortality, myocardial infarction, and need for repeat revascularization.
  • PCI may be a viable option in specific subgroups, such as those without diabetes or with less complex disease.
Abstract

Keywords:
cardiac surgery outcomes in womencoronary artery bypass graftingpercutaneous coronary interventionsex disparities

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