title: Comparison of percutaneous coronary intervention (with drug-eluting stents) versus coronary artery bypass grafting in women with severe narrowing of the left main coronary artery (from the Women-Drug-Eluting stent for LefT main coronary Artery disease Registry).
abstract: Women typically present with coronary artery disease later than men with more unfavorable clinical and anatomic characteristics. It is unknown whether differences exist in women undergoing treatment for unprotected left main coronary artery (ULMCA) disease. Our aim was to evaluate long-term clinical outcomes in women treated with percutaneous coronary intervention (PCI) with drug-eluting stents versus coronary artery bypass grafting (CABG). All consecutive women from the Drug-Eluting stent for LefT main coronary Artery disease registry with ULMCA disease were analyzed. A propensity matching was performed to adjust for baseline differences. In total, 817 women were included: 489 (59.8%) underwent treatment with PCI with drug-eluting stents versus 328 (40.2%) with CABG. Propensity score matching identified 175 matched pairs, and at long-term follow-up there were no differences in all-cause (odds ratio [OR] 0.722, 95% confidence interval [CI] 0.357 to 1.461, p=0.365) or cardiovascular (OR 1.100, 95% CI 0.455 to 2.660, p=0.832) mortality, myocardial infarction (MI; OR 0.362, 95% CI 0.094 to 1.388, p=0.138), or cerebrovascular accident (CVA; OR 1.200, 95% CI 0.359 to 4.007, p=0.767) resulting in no difference in the primary study objective of death, MI, or CVA (OR 0.711, 95% CI 0.387 to 1.308, p=0.273). However, there was an advantage of CABG in major adverse cardiovascular and cerebrovascular events (OR 0.429, 95% CI 0.254 to 0.723, p=0.001), driven exclusively by target vessel revascularization (OR 0.185, 95% CI 0.079 to 0.432, p<0.001). In women with significant ULMCA disease, no difference was observed after PCI or CABG in death, MI, and CVA at long-term follow-up.
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Gill Louise
authors.initials: GL
authors.lastname: Buchanan
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy. Electronic address: chieffo.alaide@hsr.it.
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.affiliation: A.O. Ordine Mauriziano Umberto I, Turin, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Meliga
authors.affiliation: Mount Sinai Medical Center, New York, New York.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Piera
authors.initials: P
authors.lastname: Capranzano
authors.affiliation: University of Ferrara, S. Anna Hospital, Ferrara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.affiliation: Pauls Stradins Clinical University Hospital, Riga, Latvia; University of Latvia, Riga, Latvia.
authors.forename: Inga
authors.initials: I
authors.lastname: Narbute
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
authors.affiliation: University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.affiliation: American Heart of Poland Inc., Katowice, Poland.
authors.forename: Piotr P
authors.initials: PP
authors.lastname: Buszman
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: University of Turin, S. Giovanni Battista "Molinette" Hospital, Turin, Italy.
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.affiliation: Contilia Heart and Vascular Center, Elisabeth Krankenhaus, Essen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Naber
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Ronan
authors.initials: R
authors.lastname: Margey
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Arvind
authors.initials: A
authors.lastname: Agnihotri
authors.affiliation: University of Turin, S. Giovanni Battista "Molinette" Hospital, Turin, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.affiliation: The University of York, York, United Kingdom.
authors.forename: Victoria
authors.initials: V
authors.lastname: Allgar
authors.affiliation: Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
authors.affiliation: Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefevre
authors.affiliation: Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.affiliation: Pauls Stradins Clinical University Hospital, Riga, Latvia; University of Latvia, Riga, Latvia.
authors.forename: Andrejs
authors.initials: A
authors.lastname: Erglis
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome