Department of Cardiology Chungnam National University Sejong HospitalChungnam National University School of Medicine Sejong Korea.
Department of Cardiology Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Korea.
J Am Heart Assoc. 2022 Mar;11(5):e021720. doi: 10.1161/JAHA.121.021720. Epub 2022 Feb 22.
Background There are still limited data about the differential effect of sex on long-term outcomes after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for left main coronary artery disease. This extended follow-up study of the MAIN-COMPARE (Ten-Year Outcomes of Stents Versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease) registry evaluated clinical outcomes beyond 10 years. Methods and Results Of 2240 patients with unprotected left main coronary artery disease (PCI=1102 and CABG=1138), all-cause mortality, the composite of death, Q-wave myocardial infarction, or stroke, and target vessel revascularization were separately evaluated in both sexes. Of 2240 patients, 631 (28.2%) were women and 1609 (71.8%) were men. Women had lower 10-year incidences of death and serious composite outcomes than men. The adjusted 10-year risks of adverse outcomes were similar in men. However, the adjusted 10-year risks were different according to a prespecified period in women. In the short-term (0-1 year) period, PCI had a significantly lower risk for serious composite outcomes (adjusted hazard ratio [HR], 0.41; 95% CI, 0.19-0.91; =0.03) compared with CABG. The adjusted risks for death and serious composite outcomes were significantly higher after PCI than after CABG, during the midterm (1-5 years) period (death; adjusted HR, 3.99; 95% CI, 2.01-7.92; <0.001 and composite outcome; adjusted HR, 2.93; 95% CI, 1.59-5.39; =0.001). Beyond 5 years, adjusted risks were similar after PCI and CABG in women. Conclusions In this 10-year extended follow-up study of patients undergoing left main coronary artery revascularization, we observed a time-dependent impact of sex on the long-term outcomes after PCI and CABG, especially in women, with significant interactions. However, these results warrant confirmation on larger series of studies. Registration URl: https://www.clinicaltrials.gov; Unique identifier: NCT02791412.
关于经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）治疗左主干冠状动脉疾病后对长期结局的性别差异影响，目前数据仍有限。这项 MAIN-COMPARE（左主干冠状动脉疾病支架与冠状动脉旁路移植术的 10 年结果）注册研究的扩展随访评估了 10 年以上的临床结局。
在 2240 例无保护左主干冠状动脉疾病患者（PCI=1102 例，CABG=1138 例）中，分别评估了全因死亡率、死亡、Q 波心肌梗死或卒中和血运重建的复合终点，以及两种性别患者的靶血管血运重建情况。2240 例患者中，631 例（28.2%）为女性，1609 例（71.8%）为男性。女性患者的 10 年死亡率和严重复合结局发生率均低于男性。在男性患者中，调整后的 10 年不良结局风险相似。然而，在女性患者中，根据预先设定的时间段，调整后的 10 年风险有所不同。在短期（0-1 年），与 CABG 相比，PCI 严重复合结局的风险显著降低（调整后的 HR，0.41；95%CI，0.19-0.91；=0.03）。在中期（1-5 年），与 CABG 相比，PCI 后死亡和严重复合结局的调整风险显著升高（死亡；调整后的 HR，3.99；95%CI，2.01-7.92；<0.001 和复合结局；调整后的 HR，2.93；95%CI，1.59-5.39；=0.001）。超过 5 年后，女性患者 PCI 和 CABG 的调整风险相似。
在这项对接受左主干冠状动脉血运重建治疗的患者进行的 10 年扩展随访研究中，我们观察到性别对 PCI 和 CABG 后长期结局的影响具有时间依赖性，尤其是在女性患者中，存在显著的交互作用。然而，这些结果需要更大系列的研究来证实。
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