Percutaneous coronary intervention versus coronary artery bypass grafting in left main disease according to patients' sex: A meta-analysis.

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Clinical Investigation Pub Date : 2024-11-14 DOI:10.1111/eci.14348

Pierre Meynet, Riccardo Improta, Maria Luisa Carbone, Martina Pecoraro, Ilaria Pagliassotto, Gianluca Di Pietro, Michelle Demetres, Francesco Bruno, Gaia Comitini, Attilio Leone, Eleonora Martinengo, Stefano Siliano, Fabrizio D'Ascenzo, Alaide Chieffo, Gaetano Maria De Ferrari, Mario Gaudino, Massimo Mancone, Antonino Di Franco, Ovidio De Filippo

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引用次数: 0

Abstract

Background: The role of sex in choosing between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) disease has gained interest.

Methods: Randomized controlled trials and adjusted observational studies comparing PCI versus CABG in ULMCA patients with outcomes by sex were included. The primary endpoint was major adverse cardiovascular events (MACE), with secondary endpoints being all-cause mortality and repeated revascularization.

Results: Ten studies (3 randomized, 7 observational) involving 22,141 ULMCA disease patients (13,411 PCI, 8730 CABG) with a median 5-year follow-up were included. Among males, PCI was associated with a higher risk of MACE (HR 1.18, 95% CI 1.01-1.38), while no significant difference was seen in females. However, moderator analysis showed no significant interaction between sex and revascularization strategy for MACE (p for interaction .422). No differences in all-cause mortality were observed between PCI and CABG for either sex. Repeated revascularization risk was significantly higher with PCI for both sexes (HR 3.51, 95% CI 2.21-5.59 in males and HR 4.20, 95% CI 2.57-6.87 in females).

Conclusions: In males with ULMCA disease, CABG was associated with a lower risk of MACE compared to PCI, while no significant differences were seen in females. The lack of a significant interaction between sex and revascularization strategy suggests that these findings may not reflect true sex-based effect modification. PCI was linked to a higher risk of repeated revascularization in both sexes compared to CABG.

Trial registration: The protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42024537726).

查看原文本刊更多论文

左主干疾病患者经皮冠状动脉介入治疗与冠状动脉旁路移植术的性别差异：荟萃分析。

背景：性别在选择冠状动脉旁路移植术（CABG）还是经皮冠状动脉介入治疗（PCI）治疗无保护左主干冠状动脉（ULMCA）疾病中的作用引起了人们的兴趣：方法：纳入了对 ULMCA 患者进行 PCI 与 CABG 比较的随机对照试验和调整后的观察性研究，研究结果按性别分列。主要终点是主要不良心血管事件（MACE），次要终点是全因死亡率和重复血管再通：共纳入 10 项研究（3 项随机研究，7 项观察性研究），涉及 22141 名 ULMCA 患者（13411 名 PCI 患者，8730 名 CABG 患者），中位随访 5 年。在男性中，PCI 与较高的 MACE 风险相关（HR 1.18，95% CI 1.01-1.38），而在女性中则无明显差异。然而，调节因子分析显示，性别与血运重建策略对 MACE 没有明显的交互作用（交互作用的 p 为 0.422）。在全因死亡率方面，PCI 和 CABG 在性别上均没有差异。PCI的重复血管再通风险明显高于CABG（男性HR为3.51，95% CI为2.21-5.59；女性HR为4.20，95% CI为2.57-6.87）：结论：对于患有ULMCA疾病的男性患者，与PCI相比，CABG与较低的MACE风险相关，而女性患者则无明显差异。性别与血运重建策略之间缺乏明显的交互作用，这表明这些发现可能并不反映真正的基于性别的效应改变。与 CABG 相比，PCI 在两性中都与较高的重复血管再通风险有关：该方案已在PROSPERO国际前瞻性系统综述注册中心注册（ID：CRD42024537726）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

期刊介绍： EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.