Sex-Specific Clinical Outcomes After Treatment of Left Main Coronary Artery Disease. A NOBLE Substudy

McEntegart, Margaret; Holm, Niels Ramsing; Lindsay, Martin M.; Oldroyd, Keith G.; Mäkikallio, Timo H.; Hildick‐Smith, David; Ērglis, Andrejs; Kellerth, Thomas; Davidavičius, Giedrius; Menown, Ian; Mogensen, Lone Juul Hune; Nielsen, Per Hostrup; Steigen, Terje K.; Endresen, Petter Cappelen; Spence, Mark S.; Graham, Alastair; Stradiņš, Pēteris; Anttila, Vesa; Thuesen, Leif; Christiansen, Evald Høj

doi:10.1016/j.jscai.2022.100338

Cited by 3 publications

(9 citation statements)

References 17 publications

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“…However, previous LM have been unclear and, given that LM has a larger diameter, more equivalent results. A substudy of the NOBLE trial [7] showed no difference in outcomes for male versus female, with both showing an excess of major adverse cardiovascular and cerebrovascular events (MACCE) with PCI at 5 years, although no difference in all-cause mortality.…”

Section: -Year Followupmentioning

confidence: 99%

Advances in Clinical Cardiology 2022: A Summary of Key Clinical Trials

et al. 2023

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Introduction: Over the course of 2022, numerous key clinical trials with valuable contributions to clinical cardiology were published or presented at major international conferences. This review seeks to summarise these trials and to reflect on their clinical context. Methods: The authors reviewed clinical trials presented at major cardiology conferences during 2022, including the American College of Cardiology (ACC), European Association for Percutaneous Cardiovascular Interventions (EuroPCR), European Society of Cardiology (ESC), Transcatheter Cardiovascular Therapeutics (TCT), American Heart Association (AHA), European Heart Rhythm Association (EHRA), Society for Cardiovascular Angiography and Interventions (SCAI), TVT-The Heart Summit (TVT) and Cardiovascular Research Technologies (CRT). Trials with a broad relevance to the cardiology community and those with potential to change current practice were included. Results: A total of 93 key cardiology clinical trials were identified for inclusion. Interventional cardiology data included trials evaluating the use of new generation novel stent technology and new intravascular physiology strategies such as quantitative flow ratio (QFR) to guide revascularisation in stable and unstable coronary artery disease. New trials in acute coronary syndromes and intervention focused on long-term outcomes of optimal medical therapy (OMT), revascularisation in ischaemic dysfunction and left main (LM) intervention. Structural intervention trials included latest data on optimal timing and anticoagulation strategies in transcatheter aortic valve replacement (TAVR), in addition to expanding evidence in mitral and tricuspid valve interventions. Heart failure data included trials with sodium-glucose cotransporter 2 (SGLT2) inhibitors, iron replacement and novel drugs such as omecamtiv. Prevention trials included new data on proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitors and polypill strategies. In electrophysiology, new data regarding optimal timing of ablative therapy for atrial fibrillation (AF) in addition to novel screening strategies were evaluated. Conclusion: This article presents a summary of key clinical cardiology trials published and presented during the past year and should be of interest to both practising clinicians and researchers.

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Section: -Year Followupmentioning

confidence: 99%

Advances in Clinical Cardiology 2022: A Summary of Key Clinical Trials

et al. 2023

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“…No entanto, o sexo não foi um preditor independente de desfechos adversos após a RVM, conclusão encontrada também no estudo NOBLE. 267 …”

Section: 4 Tratamento Percutâneo Da Doença Aterotrombótica Coronária ...unclassified

“…However, sex was not an independent predictor of post-MRV adverse outcomes, the same conclusion of the NOBLE study. 267 …”

Section: 4 Percutaneous Treatment Of Coronary Atherothrombotic Diseas...mentioning

confidence: 99%

Posicionamento sobre Doença Isquêmica do Coração – A Mulher no Centro do Cuidado – 2023

Oliveira¹,

Almeida²,

Rassi³

et al. 2023

Arquivos Brasileiros De Cardiologia

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“…There are no specific trials looking at PCI versus CABG in LMS disease in women; however, the four main trials (SYNTAX, EXCEL, NOBLE, PRECOMBAT) have reported gender-stratified outcomes. [11][12][13][14] The SYNTAX trial compared PCI to CABG in patients with LMS CAD or three-vessel disease. 15 At 5-year follow-up, major adverse cardiac and cerebrovascular events (MACCE; all-cause mortality, stroke, MI, and repeat revascularization) were significantly higher in the PCI than CABG arm, with sex an important driver of the mortality difference between groups (PCI arm: adjusted [a] HR for women 1.7, 95% CI [1.11-2.60]; CABG arm: aHR 0.59, 95% CI [0.332-1.10]).…”

Section: Randomized Trials Of Pci Versus Cabg In Lms Coronary Artery ...mentioning

confidence: 99%

“…10 The NOBLE trial randomized patients with LMS disease to PCI or CABG. 13 The primary endpoint was a composite of all-cause mortality, nonprocedural MI, repeat revascularization, and stroke. Overall, 1,201 patients were included in the trial, with 1,184 in the 5-year follow-up, 22% of whom were women (n=256).…”

Section: Randomized Trials Of Pci Versus Cabg In Lms Coronary Artery ...mentioning

confidence: 99%

Outcomes of Complex Percutaneous Cardiac Interventions in Women

Alasnag,

Paradies,

Ryan

et al. 2023

US Cardiol

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Complex percutaneous cardiac intervention (PCI) is a growing procedure in modern day cath labs. The treated population is often older, with multiple comorbidities, complex coronary anatomy, left ventricular dysfunction, and possibly concomitant valvular heart disease and/or cardiogenic shock. As such, PCI of bifurcations, chronic total occlusions, and atherectomy coronary interventions are becoming more common. The outcomes in terms of acute procedural success, procedure-related complications, and long-term mortality or heart failure hospitalizations are important to consider. Unfortunately, to date there is a paucity of data identifying sex and gender disparities following such interventions. With respect to bifurcation lesions, women usually have more comorbidities with less complex coronary anatomy. However, despite less complex anatomy, women have a significantly increased risk of MI. These differences are also noted with left main stem and multivessel disease, during which women appear to have a trend towards worse outcomes following PCI compared with coronary artery bypass grafting. Randomized trials have revealed that women present with increased cardiovascular risk factors, which may contribute to adverse longer-term outcomes. Revascularization of women with concomitant valvular heart disease is particularly challenging because the existing data are conflicted on not only the indication, but also the timing of revascularization. Similarly, women undergoing PCI of calcified lesions with drug-eluting stents have a worse clinical profile and remain at increased ischemic risk. The lower incidence of coronary calcification in women, combined with the under-representation of women in randomized trials, poses a real challenge when attempting to address safety and survival benefit in women undergoing complex interventions. This warrants dedicated trials exploring the safety and efficacy of complex interventions in women.

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Sex-Specific Clinical Outcomes After Treatment of Left Main Coronary Artery Disease. A NOBLE Substudy

Cited by 3 publications

References 17 publications

Advances in Clinical Cardiology 2022: A Summary of Key Clinical Trials

Advances in Clinical Cardiology 2022: A Summary of Key Clinical Trials

Posicionamento sobre Doença Isquêmica do Coração – A Mulher no Centro do Cuidado – 2023

Outcomes of Complex Percutaneous Cardiac Interventions in Women

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