10-year MACCE after left main CAD revascularization does not differ by sex
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Among patients with left main CAD, the incidence of MACCE was similar with coronary revascularization in male and female patients, according to 10-year results of the PRECOMBAT trial.
According to Yujin Yang, MD, of University of Ulsan College of Medicine in Seoul, South Korea, and colleagues, limited data exist on the long-term prognostic impact of sex and sex-treatment interactions in patients with left main CAD undergoing coronary revascularization. This led them to assess the long-term effects of sex and related differential outcomes after PCI or CABG in this patient population.
Yang and colleagues defined the primary outcome as MACCE — a composite of death, MI, stroke or ischemia-driven target vessel revascularization — at 10 years.
The study included 600 patients (77% men) with left main CAD who were randomly assigned to PCI with drug-eluting stents or CABG. Patients were enrolled from April 2004 to August 2009.
Compared with male patients, female patients had a lower proportion of current smokers (P < .001) and higher EuroSCORE (P <.001), whereas other clinical and anatomical characteristics were similar between the sexes.
In the overall cohort, 10-year rates of MACCE were similar between sexes (men, 27.3%; women, 27%; adjusted HR = 1.06; 95% CI, 0.7-1.59); similarly, these rates did not differ in the PCI arm (men, 30.6%; women, 27.1%; aHR = 1.19; 95% CI, 0.69-2.05) or the CABG arm (men, 24%; women, 26.9%; aHR = 0.93; 95% CI, 0.53-1.62).
Furthermore, the risks for MACCE at 10 years were similar between PCI and CABG in both male (aHR = 1.37; 95% CI, 0.95-1.97) and female (aHR = 1.07; 95% CI, 0.56-2.07) patients. Researchers also found no significant sex-treatment interaction in the adjusted risk for 10-year MACCE (P for interaction = .52).
“In this 10-year report of the PRECOMBAT trial, we did not find differential prognostic effects of sex on the long-term risk of MACCE,” Yang and colleagues wrote. “Moreover, the rates of MACCE were similar after PCI and CABG both in male and female subjects without a significant interaction between sex and the relative treatment effect. The prognostic value and clinical adaptation of the sex-specific factor in patients with [left main CAD] for use in coronary heart team discussions regarding the optimal revascularization strategy should be further validated in larger sized clinical studies in the contemporary revascularization setting.”
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