Department of Cardiovascular Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Kingdom of Bahrain, Manama, Bahrain.
Angiology. 2024 Feb;75(2):182-189. doi: 10.1177/00033197231162481. Epub 2023 Mar 11.
Currently, gender is not considered in the choice of the revascularization strategy for patients with unprotected left main coronary artery (ULMCA) disease. This study analyzed the effect of gender on the outcomes of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) in patients with ULMCA disease. Females who had PCI (n = 328) were compared with females who had CABG (n = 132) and PCI in males (n = 894) was compared with CABG (n = 784). Females with CABG had higher overall hospital mortality and major adverse cardiovascular events (MACE) than females with PCI. Male patients with CABG had higher MACE; however, mortality did not differ between males with CABG vs PCI. In female patients, follow-up mortality was significantly higher in CABG patients, and target lesion revascularization was higher in patients with PCI. Male patients had no difference in mortality and MACE between groups; however, MI was higher with CABG, and congestive heart failure was higher with PCI. In conclusion, women with ULMCA disease treated with PCI could have better survival with lower MACE compared with CABG. These differences were not evident in males treated with either CABG or PCI. PCI could be the preferred revascularization strategy in women with ULMCA disease.
目前，在选择无保护左主干冠状动脉（ULMCA）疾病患者的血运重建策略时，并未考虑性别因素。本研究分析了性别对 ULMCA 疾病患者经皮冠状动脉介入治疗（PCI）与冠状动脉旁路移植术（CABG）治疗结局的影响。将接受 PCI 的女性患者（n=328）与接受 CABG 的女性患者（n=132）进行比较，并将接受 PCI 的男性患者（n=894）与接受 CABG 的男性患者（n=784）进行比较。与 PCI 相比，CABG 组的女性患者总体住院死亡率和主要不良心血管事件（MACE）更高。与 PCI 相比，CABG 组的男性患者 MACE 更高；但死亡率在 CABG 与 PCI 组之间无差异。在女性患者中，CABG 组的随访死亡率明显更高，而 PCI 组的靶病变血运重建更高。男性患者在死亡率和 MACE 方面在两组之间无差异；但 CABG 组的心肌梗死更高，而 PCI 组的充血性心力衰竭更高。总之，与 CABG 相比，接受 PCI 治疗的 ULMCA 疾病女性患者的生存率更高，MACE 更低。在接受 CABG 或 PCI 治疗的男性患者中，这些差异并不明显。对于 ULMCA 疾病女性患者，PCI 可能是首选的血运重建策略。
