Author + information
- Gregg W. Stone,
- Rafael Cavalcante,
- Ari P. Kappetein,
- Joseph Sabik,
- Adrian Banning,
- David Taggart,
- Manel Sabate,
- Jose Polmar,
- Piet Boonstra,
- Nicholas Lembo,
- Charles Simonton,
- Yoshinobu Onuma and
- Patrick W. Serruys
Background: The impact of sex on outcomes of patients with unprotected left-main disease (UPLMD) treated with up-to-date percutaneous coronary intervention (PCI) and coronary bypass graft (CABG) techniques is still unknown, and the existing literature harbors conflicting data. In the SYNTAX trial, female sex was an independent correlate of 4-year mortality in the PCI arm, but not in the CABG arm. A significant interaction effect was present between sex and CABG vs. PCI for that outcome. This finding lead to the inclusion of sex in the SYNTAX II score mortality prediction model that provides guidance for the selection of the revascularization strategy in patients with multivessel disease and/or UPLMD. Conversely, this worse prognosis for women treated with PCI was not observed in the BEST and PRECOMBAT trials.
Methods: The Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial randomized 1905 patients with UPLMD to undergo CABG or PCI. The primary endpoint was the composite of all-cause death, myocardial infarction or stroke at a median follow-up of 3 years. The present study reports the pre-specified sex subgroup analysis of the trial.
Results: Of the total population, 441 (23%) were female and 1464 (77%) were male patients. Compared to men, women were older and had a worse baseline risk profile with a higher prevalences of hyperlipidemia, hypertension, medically treated diabetes, and chronic kidney disease. Regarding coronary anatomy, women had more ostial and less distal bifurcation left main lesions, as well as lower anatomic SYNTAX scores and fewer non left main diseased vessels, as compared to men. At the moment of the submission of this abstract, outcomes data of the trial are still under embargo.
Conclusions: In the EXCEL trial, women had a worse baseline risk profile but less complex coronary anatomy than men. At ACC 2017 we intend to present all outcomes data of the trial according to sex and treatment arm.
Moderated Poster Contributions
Interventional Cardiology Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 10:15 a.m.-10:25 a.m.
Session Title: PCI Strategies and Outcomes Unique to Women
Abstract Category: 21. Interventional Cardiology: Coronary Intervention: Devices
Presentation Number: 1214M-07
- 2017 American College of Cardiology Foundation