Sex-specific clinical outcomes after treatment of left main coronary artery disease. A NOBLE substudy

McEntegart, M. B. et al. (2022) Sex-specific clinical outcomes after treatment of left main coronary artery disease. A NOBLE substudy. Journal of the Society for Cardiovascular Angiography and Interventions, 1(4), 100338. (doi: 10.1016/j.jscai.2022.100338)

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Abstract

Background: While female sex has been associated with worse outcomes following coronary revascularization, previous analyses in left main coronary artery (LMCA) disease have been conflicting. In addition, a signal that increased mortality may be specific to women treated with percutaneous coronary intervention (PCI) requires further investigation. Methods: Nordic-Baltic-British left main revascularization study (NOBLE) was a randomized trial comparing PCI to coronary artery bypass surgery (CABG) in patients with LMCA disease. The primary endpoint was a composite of all-cause mortality, nonprocedural myocardial infarction, repeat revascularization, and stroke (major adverse cardiovascular and cerebrovascular events [MACCE]). We report the 5-year sex-specific outcomes. Results: Of 1184 patients analyzed, 256 (22%) were female and 928 (78%) were male. There were no significant within-sex differences in baseline characteristics, disease location, or complexity between those treated with PCI and those with CABG. The 5-year MACCE rates were 29% and 15% in females and 28% and 20% in males treated with PCI and CABG, respectively. Within both sexes, there was an increased risk of MACCE with PCI compared with CABG, but no difference in all-cause mortality. On multivariate analysis, female sex was not an independent predictor of MACCE. Conclusions: Following the treatment of LMCA disease, long-term outcomes favored CABG over PCI in both sexes. Importantly, there was no difference in all-cause mortality in females or males at 5 ​years.

Item Type:Articles
Additional Information:Funding source: Unrestricted grant from Biosensors.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Oldroyd, Dr Keith and McEntegart, Dr Margaret
Authors: McEntegart, M. B., Holm, N. R., Lindsay, M. M., Oldroyd, K. G., Mäkikallio, T., Hildick-Smith, D., Erglis, A., Kellerth, T., Davidavicius, G., Menown, I. B.A., Mogensen, L. J.H., Nielsen, P. H., Steigen, T. K., Endresen, P. C., Spence, M. S., Graham, A. N.J., Stradins, P., Anttila, V., Thuesen, L., and Christiansen, E. H.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Journal of the Society for Cardiovascular Angiography and Interventions
Publisher:Elsevier
ISSN:2772-9303
ISSN (Online):2772-9303
Published Online:30 May 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Journal of the Society for Cardiovascular Angiography and Interventions 1(4): 100338
Publisher Policy:Reproduced under a Creative Commons License

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