For research, it was determined that there was a debate on whether sex had a role in the revascularization approach for unprotected left primary coronary artery disease. Women treated with percutaneous coronary intervention had a higher death rate than those treated with coronary artery bypass grafting. The DELTA (Drug-Eluting Stents for Left Main Coronary Artery Disease) and DELTA2 registries were global, multicentric registries that evaluated the outcomes of patients who had unprotected left primary myocardial artery disease and were undergoing coronary revascularization. Death, myocardial infarction, or cerebrovascular accidents were the major outcomes. There were 6,253 patients in all, with 1,689 (27%) women. Women were older than men and had a higher risk of diabetes and chronic renal disease (P<0.05). A significant interaction between sex and revascularization technique was detected for the major endpoint (Pint=0.012) and all-cause death (Pint=0.037) after a median follow-up of 29 months (interquartile range 12–49). Compared with percutaneous coronary intervention, coronary artery bypass grafting was associated with a lower risk of the primary endpoint (event rate 9.5% vs 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% vs 11.7%; AHR, 0.50; 95% CI, 0.30–0.82) in women, but no significant differences were determined in men. Coronary artery bypass grafting was associated with a lower risk of death, myocardial infarction, or cerebrovascular accidents in women undergoing coronary revascularization for unprotected left main coronary artery disease. In contrast, there were no significant differences between coronary artery bypass grafting and percutaneous coronary intervention in men. More research was needed to find the best revascularization method in women with unprotected left main coronary artery disease.

 

Link:www.ahajournals.org/doi/10.1161/JAHA.121.022320