Prognostic Value of Sex After Revascularization for Left Main Coronary Disease: Extended PRECOMBAT Study.
JACC Asia
; 2(1): 19-29, 2022 Feb.
Article
em En
| MEDLINE
| ID: mdl-36340254
ABSTRACT
Background:
Female subjects have poorer outcomes in left main coronary artery (LMCA) disease compared with male subjects. However, limited information is available on the long-term prognostic impact of sex and sex-treatment interactions in patients with LMCA disease undergoing coronary revascularization.Objectives:
The goal of this study was to investigate the long-term effects of sex and related differential outcomes after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in LMCA disease.Methods:
The extended PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) trial evaluated the >10-year clinical outcomes in patients with LMCA disease randomized to undergo PCI with drug-eluting stents (n = 300) or CABG (n = 300). The primary outcome was major adverse cardiac or cerebrovascular events (MACCE) (composite of death, myocardial infarction, stroke, or ischemia-driven target vessel revascularization) at 10 years.Results:
Of the 600 patients, 459 (76.5%) were male. The 10-year rates of MACCE were similar between male and female subjects in the overall cohort (27.3% vs 27.0%; adjusted hazard ratio [aHR] 1.06; 95% confidence interval [CI] 0.70-1.59), the PCI arm (30.6% vs 27.1%; aHR 1.19; 95% CI 0.69-2.05), and the CABG arm (24.0% vs 26.9%; aHR 0.93; 95% CI 0.53-1.62). The 10-year risks for MACCE did not significantly differ between PCI and CABG in both male (aHR 1.37; 95% CI 0.95-1.97) and female (aHR 1.07; 95% CI 0.56-2.07) subjects. There was no significant sex-treatment interaction regarding the adjusted risk of MACCE at 10 years (P for interaction = 0.52).Conclusions:
In this 10-year follow-up of the PRECOMBAT trial, there was no sex-related impact on the long-term risk of MACCE after PCI and CABG for LMCA disease. (Ten-Year Outcomes of PRECOMBAT Trial; NCT03871127).
CABG, coronary artery bypass grafting; CAD, coronary artery disease; CI, confidence interval; DES, drug-eluting stents; HR, hazard ratio; LMCA, left main coronary artery; MACCE, major adverse cardiac or cerebrovascular events; MI, myocardial infarction; PCI, percutaneous coronary intervention; RCT, randomized controlled trial; TVR, target vessel revascularization; coronary artery bypass surgery; left main coronary artery disease; mortality; percutaneous coronary intervention; sex
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1
Coleções:
01-internacional
Base de dados:
MEDLINE
Contexto em Saúde:
6_ODS3_enfermedades_notrasmisibles
Problema de saúde:
6_cardiovascular_diseases
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
Aspecto:
Patient_preference
Idioma:
En
Revista:
JACC Asia
Ano de publicação:
2022
Tipo de documento:
Article