title: Coronary bypass versus percutaneous intervention: sex matters. The impact of gender on long-term outcomes of coronary revascularization.
abstract: Women have a higher mortality than men following coronary artery bypass grafting (CABG). The influence of patient sex on outcomes of percutaneous coronary interventions (PCI) is controversial. Since patient selection for randomized clinical trials may not reflect clinical practice, we investigated the impact of sex on outcomes of CABG versus PCI in a comprehensive registry of coronary revascularization (CR).
  
  
  
  All patients undergoing CR in a network of eight community hospitals were enrolled. Follow-up was obtained after 5 years (median, 79.7 months). ST-elevation myocardial infarction (MI) patients were excluded. Propensity-score matching accounted for differences between groups.
  
  
  
  There were 2162 men (673 CABG, 1489 PCI) and 991 women (294 CABG, 697 PCI). Survival free from major adverse cardiac events (MACE)-all cause mortality, nonfatal MI, re-intervention at 5 years for PCI versus CABG was 77.1 +/- 1.1 vs. 83.1 +/- 1.5, hazard ratio (HR) 0.588 (95% confidence interval [CI]: 0.491-0.704; P < 0.001) for men, but 75.0 +/- 1.6 vs. 74.5 ± 2.5, HR 0.869 (95% CI: 0.687-1.100; P  = 0.24) for women. After matching, MACE-free survival for men remained significantly different, 69.5 +/- 2.2 vs. 79.5 +/- 2.0, HR 0.548 (95% CI: 0.424-0.682; P < 0.001) but not for women, 68.1 +/- 3.4 vs. 69.4 +/- 3.4, HR 0.752 (95% CI: 0.540-1.049; P  = 0.093).
  
  
  
  In a 'real world' unselected cohort of CR patients, men enjoy improved survival and reduced MACE with CABG versus PCI. Outcomes for women are worse than for men and are equivalent with either procedure, emphasizing importance of accounting for sex in assessing outcomes of comparative CR procedures.
authors.affiliation: Department of Surgery, Columbia University, New York, NY, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Kurlansky
authors.affiliation: Medical City Dallas Hospital, Dallas, TX, USA.
authors.forename: Morley
authors.initials: M
authors.lastname: Herbert
authors.affiliation: Medical City Dallas Hospital, Dallas, TX, USA.
authors.forename: Syma
authors.initials: S
authors.lastname: Prince
authors.affiliation: Department of Cardiac Surgery, Baylor Health Care System, Plano, TX, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Coronary disease; Perioperative issues and risk analysis