Abstract
BACKGROUND: Controversy exists over whether sex has significant interaction with revascularization strategy for unprotected left main coronary artery disease. Higher mortality has been reported among women treated with percutaneous coronary intervention compared with coronary artery bypass grafting. METHODS AND RESULTS: The DELTA (Drug-Eluting Stents for Left Main Coronary Artery Disease) and DELTA-2 registries are in-ternational, multicentric registries evaluating the outcomes of subjects undergoing coronary revascularization for unprotected left main coronary artery disease. The primary outcome was a composite of death, myocardial infarction, or cerebrovascular accidents. The population consisted of 6253 patients, including 1689 (27%) women. Women were older and more likely to have diabetes and chronic kidney disease than men (P<0.05). At a median follow-up of 29 months (interquartile range 12–49), a significant interaction between sex and revascularization strategy was observed for the primary end point (p int =0.012) and all-cause death (p int =0.037). Among women, compared with percutaneous coronary intervention, coronary artery bypass grafting was associated with lower risk of the primary end point (event rate 9.5% versus 15.3%; adjusted hazard ratio [AHR], 0.53; 95% CI, 0.35–0.79, P<0.001) and all-cause death (event rate 5.6% versus 11.7% AHR, 0.50; 95% CI, 0.30–0.82) and no significant differences were observed in men. CONCLUSIONS: In women undergoing coronary revascularization for unprotected left main coronary artery disease, coronary artery bypass grafting was associated with lower risk of death, myocardial infarction, or cerebrovascular accidents whereas no significant differences between coronary artery bypass grafting and percutaneous coronary intervention were observed in men. Further dedicated studies are needed to determine the optimal revascularization strategy in women with unprotected left main coronary artery disease.
| Original language | English |
|---|---|
| Article number | e022320 |
| Journal | Journal of the American Heart Association |
| Volume | 11 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 1 Mar 2022 |
Bibliographical note
Funding Information:Dr Giustino reports receiving consulting fees from Bristol-Myers Squibb/ Pfizer; Dr Daemen received institutional grant/research support from Astra Zeneca, Abbott Vascular, Boston Scientific, ACIST Medical, Medtronic, Pie Medical, ReCor Medical, and PulseCath, and consultancy and speaker fees from ACIST Medical, Boston Scientific, ReCor Medical, Pie Medical, Medtronic, and Pulse Cath; Dr Makkar received grants and personal fees from Abbott, grants, personal fees from Edwards Lifesciences, grants and personal fees from Boston Scientific, grants and personal fees from Medtronic; Dr Kirtane reports institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, Philips, ReCor Medical. Personal: conference honoraria and travel/meals only; Dr Valgimigli reports personal fees from Astra Zeneca, grants and personal fees from Terumo, personal fees from Alvimedica/CID, personal fees from Abbott Vascular, personal fees from Daiichi Sankyo, personal fees from Opsens, personal fees from Bayer, personal fees from CoreFLOW, personal fees from Idorsia Pharmaceuticals LTD, personal fees from Universität Basel | Dept. Klinische Forschung, personal fees from Vifor, personal fees from Bristol Myers Squib SA, personal fees from iVascular, personal fees from Medscape; Dr. Mehran personal fees from Sanofi Aventis, grants and personal fees from Bayer, personal fees from Janssen, grants and personal fees from Daiichi-Sankyo; Dr Chieffo has reports personal fees from Abiomed, personal fees from Abbott Vascular, personal fees from Cardinal Health, personal fees from Biosensor, personal fees from Magenta medical. The remaining authors have no disclosures to report.
Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
