Time-Dependent Impact of Sex on the Long-Term Outcomes After Left Main Revascularization

Yong-Hoon Yoon, Jung-Min Ahn, Jung Bok Lee, Do-Yoon Kang, Hanbit Park, Yeong Jin Jeong, Junghoon Lee, Ju Hyeon Kim, Yujin Yang, Junho Hyun, Pil Hyung Lee, Duk-Woo Park, Seung-Jung Park, Yong-Hoon Yoon, Jung-Min Ahn, Jung Bok Lee, Do-Yoon Kang, Hanbit Park, Yeong Jin Jeong, Junghoon Lee, Ju Hyeon Kim, Yujin Yang, Junho Hyun, Pil Hyung Lee, Duk-Woo Park, Seung-Jung Park

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.

Keywords: coronary artery bypass surgery; left main coronary artery disease; outcomes; percutaneous coronary intervention; sex.

Figures

Figure 1. Crude 10‐year Kaplan‐Meier curves for…
Figure 1. Crude 10‐year Kaplan‐Meier curves for clinical events stratified by sex and revascularization strategies in the overall cohort.
A, Death. B, Death, Q‐wave myocardial infarction (MI), or stroke. C, Target vessel revascularization. CABG, indicates coronary artery bypass grafting; and PCI, percutaneous coronary intervention.
Figure 2. Adjusted 10‐year Kaplan‐Meier curves for…
Figure 2. Adjusted 10‐year Kaplan‐Meier curves for clinical events stratified by sex and revascularization strategies in the overall cohort.
A, Death. B, Death, Q‐wave myocardial infarction (MI), or stroke. C, Target vessel revascularization. CABG indicates coronary artery bypass grafting; and PCI, percutaneous coronary intervention.
Figure 3. Impact of sex on the…
Figure 3. Impact of sex on the relative risks for clinical outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
MI indicates myocardial infarction; and TVR, target vessel revascularization.

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