McEntegart Margaret B, Holm Niels R, Lindsay Martin M, Oldroyd Keith G, Mäkikallio Timo, Hildick-Smith David, Erglis Andrejs, Kellerth Thomas, Davidavicius Giedrius, Menown Ian B A, Mogensen Lone J H, Nielsen Per H, Steigen Terje K, Endresen Petter C, Spence Mark S, Graham Alastair N J, Stradins Peteris, Anttila Vesa, Thuesen Leif, Christiansen Evald H
Department of Cardiology, Golden Jubilee National Hospital, University of Glasgow, Glasgow, United Kingdom.
Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
J Soc Cardiovasc Angiogr Interv. 2022 May 30;1(4):100338. doi: 10.1016/j.jscai.2022.100338. eCollection 2022 Jul-Aug.
While female sex has been associated with worse outcomes following coronary revascularization, previous analyses in left main coronary artery (LMCA) disease have been conflicting. In addition, a signal that increased mortality may be specific to women treated with percutaneous coronary intervention (PCI) requires further investigation.
Nordic-Baltic-British left main revascularization study (NOBLE) was a randomized trial comparing PCI to coronary artery bypass surgery (CABG) in patients with LMCA disease. The primary endpoint was a composite of all-cause mortality, nonprocedural myocardial infarction, repeat revascularization, and stroke (major adverse cardiovascular and cerebrovascular events [MACCE]). We report the 5-year sex-specific outcomes.
Of 1184 patients analyzed, 256 (22%) were female and 928 (78%) were male. There were no significant within-sex differences in baseline characteristics, disease location, or complexity between those treated with PCI and those with CABG. The 5-year MACCE rates were 29% and 15% in females and 28% and 20% in males treated with PCI and CABG, respectively. Within both sexes, there was an increased risk of MACCE with PCI compared with CABG, but no difference in all-cause mortality. On multivariate analysis, female sex was not an independent predictor of MACCE.
Following the treatment of LMCA disease, long-term outcomes favored CABG over PCI in both sexes. Importantly, there was no difference in all-cause mortality in females or males at 5 years.
虽然女性性别与冠状动脉血运重建术后较差的预后相关，但先前对左主干冠状动脉（LMCA）疾病的分析结果存在矛盾。此外，有迹象表明死亡率增加可能是接受经皮冠状动脉介入治疗（PCI）的女性所特有的，这需要进一步研究。
北欧-波罗的海-英国左主干血运重建研究（NOBLE）是一项随机试验，比较了LMCA疾病患者接受PCI与冠状动脉旁路移植术（CABG）的疗效。主要终点是全因死亡率、非手术性心肌梗死、再次血运重建和中风的综合指标（主要不良心血管和脑血管事件[MACCE]）。我们报告了5年的性别特异性结果。
在分析的1184例患者中，256例（22%）为女性，928例（78%）为男性。接受PCI和CABG治疗的患者在基线特征、疾病部位或复杂性方面，性别内无显著差异。接受PCI和CABG治疗的女性5年MACCE发生率分别为29%和15%，男性分别为28%和20%。在两性中，与CABG相比，PCI治疗的MACCE风险增加，但全因死亡率无差异。多变量分析显示，女性性别不是MACCE的独立预测因素。
治疗LMCA疾病后，两性的长期预后均显示CABG优于PCI。重要的是，5年时女性和男性的全因死亡率无差异。
