Objective
To assess whether outcomes following percutaneous coronary intervention (PCI) versus
coronary artery bypass grafting (CABG) for left main coronary artery (LMCA) disease
differ between men and women.
Background
Current guidelines recommend either PCI or CABG for patients with unprotected LMCA
disease and low-to-intermediate anatomical complexity. However, it is unclear whether
these guidelines apply to women, who are underrepresented in clinical trials.
Methods
An electronic search was performed to identify studies reporting sex-specific outcomes
after PCI versus CABG in patients with LMCA disease. Trial level hazard ratios (HRs)
and 95% confidence intervals (CIs) were pooled by random-effects modelling.
Results
Eight (8) studies met inclusion criteria, comprising 13,066 patients (24.3% women).
In both sexes, there was no difference between PCI and CABG with respect to the primary
composite endpoint of death, myocardial infarction or stroke (HR in women: 1.03, 95%
CI 0.76–1.40; HR in men: 1.04, 95% CI 0.92–1.17). However, both sexes were more likely
to require repeat revascularisation after PCI. There was no interaction between sex
and treatment effect for the primary composite endpoint nor for the individual outcomes
of death, stroke and repeat revascularisation. However, in women the risk of myocardial
infarction was higher after PCI compared with CABG (HR 1.84, 95% CI 1.06–3.18), with
a trend toward the opposite in men (HR 0.78, 95% CI 0.54–1.13; p-interaction=0.01).
Conclusion
Percutaneous coronary intervention and CABG have a comparable risk of the composite
outcome of death, stroke or myocardial infarction in patients undergoing revascularisation
for LMCA disease, with no significant interaction between sex and treatment effect.
Keywords
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Article info
Publication history
Published online: January 12, 2022
Accepted:
October 28,
2021
Received in revised form:
September 27,
2021
Received:
June 1,
2021
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
