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

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.

Development and validation of a nomogram for predicting overall survival of patients with ischemic cardiomyopathy and heart failure: a post-hoc analysis of the Surgical Treatments for Ischemic Heart Failure (STICH) trail

“…20 The extended follow-up of the MAIN-COMPARE (Ten-Year Outcomes of Stents Versus Coronary-Artery Bypass Grafting for left Main Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease) trail also revealed lower all-cause mortality and serious composite outcomes at 10 years in female compared with male, and this difference was mainly driven by the higher event rate in male during the late period between 5 and 10 years. 21 On the contrary, multiple lines of evidence have documented the poorer prognosis of female compared to male due to various pathologic resultant such as medical co-morbid conditions, coronary microvascular dysfunction and diastolic filling pattern. 22–24 .…”

Outcomes of Complex Percutaneous Cardiac Interventions in Women

“…18 The MAIN-COMPARE Registry showed that at 10 years women had a lower incidence of death and serious adverse outcomes than men, with the risks of adverse outcomes varying by revascularization technique over time. 19 In the short term (up to 1 year), compared with CABG, PCI had a lower risk for composite serious outcomes, namely death, MI, stroke, or repeat revascularization (aHR 0.41; 95% CI [0.19-0.91]; p=0.03). From 1 to 5 years, PCI had a higher risk for death (aHR 33.99; 95% CI [2.01-7.92]; p<0.001) and composite outcomes (aHR 2.93; 95% CI [1.59-5.39]; p=0.001).…”

“…The 5-to 10-year risks were similar for PCI and CABG in women. 19 Overall, the optimal revascularization modality for women with LMS CAD remains undetermined. Women appear to have a trend towards worse outcomes with PCI than CABG, but all trials have enrolled relatively small numbers of female patients.…”

Sex‐Based Differences in Revascularization Outcomes: Is It Time for a Dedicated Randomized Trial in Women?

“…In this issue of the Journal of the American Heart Association (JAHA) , Yoon et al address the important question of long‐term outcomes in women undergoing PCI versus CABG for LMCAD. 17 This extended follow‐up of the MAIN‐COMPARE registry (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization from Multi‐Center Registry) included consecutive patients who underwent PCI or CABG for LMCAD in South Korea from January 2000 to June 2006 with either bare metal stents or first‐generation DES (the devices available at the time of treatment). To compensate for the nonrandomized design of the study, the authors used inverse‐probability‐treatment weighting for the primary analysis.…”