Revascularization Options for Females With Multivessel Coronary Artery Disease

Gul, Burcu; Shah, Tayyab; Head, Stuart J.; Chieffo, Alaide; Hu, Xin; Li, Fangyong; Brackett, Alexandria; Gesick, Cameron; Bisarya, Priyanka K.; Lansky, Alexandra J.

doi:10.1016/j.jcin.2019.12.036

Cited by 17 publications

(10 citation statements)

References 5 publications

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“…In a propensity–matched analysis based on the US Nationwide Inpatient Sample that included a total of 3 603 142 patients (1 180 436 women) undergoing percutaneous coronary intervention (PCI) or CABG for acute myocardial infarction, in-hospital mortality was higher for women than men regardless of revascularization strategy . A study-level meta-analysis of 6 randomized clinical trials comparing PCI and CABG in 1909 women with multivessel and/or left main disease found that PCI was associated with an increased risk of all-cause death, myocardial infarction, or stroke (HR, 1.31; 95% CI, 1.05-1.63) compared with CABG . However, studies directly comparing CABG with PCI in women are lacking and current guideline recommendations on the choice of revascularization strategy are derived from studies enrolling predominantly men, thus limiting the generalizability of findings to women.…”

Section: Discussionmentioning

confidence: 99%

“…23 A study-level meta-analysis of 6 randomized clinical trials comparing PCI and CABG in 1909 women with multivessel and/or left main disease found that PCI was associated with an increased risk of all-cause death, myocardial infarction, or stroke (HR, 1.31; 95% CI, 1.05-1.63) compared with CABG. 24 However, studies directly comparing CABG with PCI in women are lacking and current guideline recommendations on the choice of revascularization strategy are derived from studies enrolling predominantly men, thus limiting the generalizability of findings to women. Reducing mortality in women after CABG likely entails a multifactorial approach.…”

Section: Discussionmentioning

confidence: 99%

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Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020

et al. 2023

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ImportanceIt has been reported that women undergoing coronary artery bypass have higher mortality and morbidity compared with men but it is unclear if the difference has decreased over the last decade.ObjectiveTo evaluate trends in outcomes of women undergoing coronary artery bypass in the US from 2011 to 2020.Design, Setting, and ParticipantsThis retrospective cohort study at hospitals contributing to the Adult Cardiac Surgery Database of the Society of Thoracic Surgeons included 1 297 204 patients who underwent primary isolated coronary artery bypass from 2011 to 2020.ExposureCoronary artery bypass.Main Outcomes and MeasuresThe primary outcome was operative mortality. The secondary outcome was the composite of operative mortality and morbidity (including operative mortality, stroke, kidney failure, reoperation, deep sternal wound infection, prolonged mechanical ventilation, and prolonged hospital stay). The attributable risk (the association of female sex with coronary artery bypass grafting outcomes) for the primary and secondary outcomes was calculated.ResultsBetween 2011 and 2020, 1 297 204 patients underwent primary isolated coronary artery bypass grafting with a mean age of 66.0 years, 317 716 of which were women (24.5%). Women had a higher unadjusted operative mortality (2.8%; 95% CI, 2.8-2.9 vs 1.7%; 95% CI, 1.7-1.7; P &lt; .001) and overall unadjusted incidence of the composite of operative mortality and morbidity compared with men (22.9%; 95% CI, 22.7-23.0 vs 16.7%; 95% CI, 16.6-16.8; P &lt; .001). The attributable risk of female sex for operative mortality varied from 1.28 in 2011 to 1.41 in 2020, with no significant change over the study period (P for trend = 0.38). The attributable risk for the composite of operative mortality and morbidity was 1.08 in both 2011 and 2020 with no significant change over the study period (P for trend = 0.71).Conclusions and RelevanceWomen remain at significantly higher risk for adverse outcomes following coronary artery bypass grafting and no significant improvement has been seen over the course of the last decade. Further investigation into the determinants of operative outcomes in women is urgently needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020

et al. 2023

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“…46 These results are aligned with a recently published meta-analysis of 1,909 women from 6 randomized trials, demonstrating that women with MVD and/or LMD had a 30% reduction in the composite of death, MI, or stroke 1-5 years after treatment with CABG compared with PCI. 47 This difference in outcomes for women is reflected in the SYNTAX II score, which adjusts female sex by a factor of 1.6 for PCI such that for any given set of criteria the SYNTAX II score will predict a higher 4-year mortality in women for PCI compared with CABG 48 ; however, due to the limitations of the original SYNTAX trial (specifically that <12% of patients were women and that first-generation drug-eluting stents were used), contemporary studies are needed to evaluate the effects of sex on outcomes after CABG versus PCI for MVD or LMD and to determine whether sex-specific thresholds for judging anatomic complexity are needed.…”

Section: Revascularization Versus Optimal Medical Therapy In Chronic ...mentioning

confidence: 99%

SCAI Expert Consensus Statement on Sex-Specific Considerations in Myocardial Revascularization

Lansky

Baron²,

Grines³

et al. 2022

Journal of the Society for Cardiovascular Angiography & Int

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“…Finally, there appear to be differences in outcomes between sexes in patients with multivessel coronary artery disease. A recent meta-analysis assessing PCI versus coronary artery bypass graft (CABG) revascularization showed that women had a worse overall composite outcome with PCI compared to men, with a hazard ratio of 1.31 (95% CI 1.05–1.63, p < 0.017) [ 38 ]. While only six of the 15 randomized controlled trials in the meta-analysis included sex-based data on composite outcomes of all-cause mortality, myocardial infarction, and/or stroke, this study again highlights the need for more data on sex-based outcomes in revascularization.…”

Section: Percutaneous Coronary Interventionsmentioning

confidence: 99%

Sex-Based Differences in Coronary and Structural Percutaneous Interventions

et al. 2020

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In the current state of interventional cardiology, the ability to offer advanced therapies to patients who historically were not surgical candidates has grown exponentially in the last few decades. As therapies have expanded in complex coronary and structural interventions, the nuances of treating certain populations have emerged. In particular, the role of sex-based anatomic and outcome differences has been increasingly recognized. As guidelines for cardiovascular prevention and treatment for certain conditions may vary by sex, therapeutic interventions in the structural and percutaneous coronary areas may also vary. In this review, we aim to discuss these differences, the current literature available on these topics, and areas of focus for the future.

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Revascularization Options for Females With Multivessel Coronary Artery Disease

Cited by 17 publications

References 5 publications

Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020

Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020

SCAI Expert Consensus Statement on Sex-Specific Considerations in Myocardial Revascularization

Sex-Based Differences in Coronary and Structural Percutaneous Interventions

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