Comparison of percutaneous coronary intervention (with drug-eluting stents) versus coronary artery bypass grafting in women with severe narrowing of the left main coronary artery (from the Women-Drug-Eluting stent for LefT main coronary Artery disease Registry).

Abstract

Women typically present with coronary artery disease later than men with more unfavorable clinical and anatomic characteristics. It is unknown whether differences exist in women undergoing treatment for unprotected left main coronary artery (ULMCA) disease. Our aim was to evaluate long-term clinical outcomes in women treated with percutaneous coronary intervention (PCI) with drug-eluting stents versus coronary artery bypass grafting (CABG). All consecutive women from the Drug-Eluting stent for LefT main coronary Artery disease registry with ULMCA disease were analyzed. A propensity matching was performed to adjust for baseline differences. In total, 817 women were included: 489 (59.8%) underwent treatment with PCI with drug-eluting stents versus 328 (40.2%) with CABG. Propensity score matching identified 175 matched pairs, and at long-term follow-up there were no differences in all-cause (odds ratio [OR] 0.722, 95% confidence interval [CI] 0.357 to 1.461, p=0.365) or cardiovascular (OR 1.100, 95% CI 0.455 to 2.660, p=0.832) mortality, myocardial infarction (MI; OR 0.362, 95% CI 0.094 to 1.388, p=0.138), or cerebrovascular accident (CVA; OR 1.200, 95% CI 0.359 to 4.007, p=0.767) resulting in no difference in the primary study objective of death, MI, or CVA (OR 0.711, 95% CI 0.387 to 1.308, p=0.273). However, there was an advantage of CABG in major adverse cardiovascular and cerebrovascular events (OR 0.429, 95% CI 0.254 to 0.723, p=0.001), driven exclusively by target vessel revascularization (OR 0.185, 95% CI 0.079 to 0.432, p<0.001). In women with significant ULMCA disease, no difference was observed after PCI or CABG in death, MI, and CVA at long-term follow-up.

• Authors: Gill Louise Buchanan, Alaide Chieffo, Emanuele Meliga, Roxana Mehran, Seung-Jung Park, Yoshinobu Onuma, Piera Capranzano, Marco Valgimigli, Inga Narbute, Raj R Makkar, Igor F Palacios, Young-Hak Kim, Piotr P Buszman, Tarun Chakravarty, Imad Sheiban, Christoph Naber, Ronan Margey, Arvind Agnihotri, Sebastiano Marra, Davide Capodanno, Victoria Allgar, Martin B Leon, Jeffrey W Moses, Jean Fajadet, Thierry Lefevre, Marie-Claude Morice, Andrejs Erglis, Corrado Tamburino, Ottavio Alfieri, Patrick W Serruys, Antonio Colombo
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 113 Issue 8 Pg. 1348-55 (Apr 15 2014) ISSN: 1879-1913 [Electronic] United States
• PMID: 24581924 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Topics

• Aged
• Coronary Angiography
• Coronary Artery Bypass (methods)
• Coronary Stenosis (diagnostic imaging, surgery)
• Coronary Vessels (surgery)
• Drug-Eluting Stents
• Female
• Follow-Up Studies
• Humans
• Percutaneous Coronary Intervention (methods)
• Propensity Score
• Registries
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Time Factors
• Treatment Outcome