Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Am J Cardiol. 2019 Sep 1;124(5):678-687. doi: 10.1016/j.amjcard.2019.05.061. Epub 2019 Jun 6.
Age and sex contribute to determining coronary revascularization strategies for patients with left main coronary artery (LMCA) disease. We examined age- and sex-related differences in comparative outcomes after percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG) for LMCA disease. A total of 4,001 patients with LMCA disease (men, n = 3,100, women, n = 901) who underwent PCI (n = 2,615) or CABG (n = 1,386) from the Interventional Research Incorporation Society-Left MAIN Revascularization registry were analyzed. Patients were stratified into subgroups according to the tertiles of age (<60 years, 60 to 69 years, and ≥70 years) and sex. The primary outcome was the composite of death from any cause, myocardial infarction, or stroke. During the median 6.3 years of follow-up, the adjusted risks for primary outcome after PCI relative to CABG were similar in patients aged <60 years (hazard ratio [HR]: 0.64, 95% confidence interval [CI]: 0.35 to 1.16), 60 to 69 years (HR: 1.21; 95% CI: 0.82 to 1.80), and ≥70 years (HR: 0.90; 95% CI: 0.66 to 1.22) with no significant age-related interactions (P = 0.57). The primary outcome risks following PCI versus CABG were similar between male (HR: 0.92; 95% CI: 0.72 to 1.17) and female (HR: 0.89; 95% CI: 0.52 to 1.50) (P = 0.65). Significant interactions were absent for age or sex and revascularization type for all-cause mortality (P = 0.34 for age and P = 0.99 for sex), repeat revascularization (P = 0.10 for age and P = 0.65 for sex), and major adverse cardiac or cerebrovascular events (P = 0.29 for age and P = 0.30 for sex). In conclusion, there were no significant age- or sex-related differences in comparative outcomes after PCI or CABG for LMCA disease.
年龄和性别是决定左主干冠状动脉（LMCA）疾病患者血运重建策略的重要因素。本研究旨在探讨经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）治疗 LMCA 疾病患者的年龄和性别相关的预后差异。本研究共纳入了来自介入研究协会-左主干血运重建注册研究的 4001 例 LMCA 疾病患者（男性 3100 例，女性 901 例），这些患者分别接受了 PCI（n=2615）或 CABG（n=1386）治疗。患者根据年龄（<60 岁、60-69 岁、≥70 岁）和性别被分为亚组。主要复合终点为任何原因死亡、心肌梗死或卒中。在中位随访 6.3 年期间，与 CABG 相比，年龄<60 岁（HR：0.64，95%CI：0.35 至 1.16）、60-69 岁（HR：1.21，95%CI：0.82 至 1.80）和≥70 岁（HR：0.90，95%CI：0.66 至 1.22）患者行 PCI 的主要预后结局无显著差异，且未发现年龄相关交互作用（P=0.57）。男性（HR：0.92，95%CI：0.72 至 1.17）和女性（HR：0.89，95%CI：0.52 至 1.50）患者行 PCI 与 CABG 的主要预后结局无显著差异（P=0.65）。所有原因死亡率（P=0.34）、再次血运重建（P=0.10）和主要心脏或脑血管不良事件（P=0.29）的结局无显著的年龄和性别与血运重建类型的交互作用。总之，在 LMCA 疾病患者中，PCI 或 CABG 治疗后的预后结局不存在显著的年龄或性别差异。
