Key result
Male sex was not associated with a significantly different 10-year risk of major adverse cardiac or cerebrovascular events compared to female sex in patients with left main coronary artery disease (27.3% vs 27.0%; aHR 1.06), with no significant sex-treatment interaction.
Why the study?
Limited information is available on the long-term prognostic impact of sex and sex–treatment interactions in patients with left main coronary artery disease undergoing coronary revascularization.
Does sex impact the long-term risk of major adverse cardiac or cerebrovascular events in patients with left main coronary artery disease undergoing percutaneous coronary intervention or coronary artery bypass grafting?
RCT (n=600)
Open-label
Randomized 1:1 to PCI with sirolimus-eluting stents or CABG
Yes
Does sex impact the long-term risk of major adverse cardiac or cerebrovascular events in patients with left main coronary artery disease undergoing percutaneous coronary intervention or coronary artery bypass grafting?
Hazard Ratio: 1.06 (95% CI 0.7–1.59)
Absolute Event Rate: 27.3% vs 27%
p-value: p=0.78
This 10-year follow-up of the PRECOMBAT trial demonstrates that sex does not significantly impact the long-term risk of MACCE after revascularization with either PCI or CABG for left main coronary artery disease.
Outcomes after left main revascularization do not differ by sex; confirms equitable long-term MACCE risk and supports sex-neutral guidelines.
Female subjects have poorer outcomes in left main coronary artery (LMCA) disease compared with male subjects. However, limited information is available on the long-term prognostic impact of sex and sex–treatment interactions in patients with LMCA disease undergoing coronary revascularization. The goal of this study was to investigate the long-term effects of sex and related differential outcomes after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in LMCA disease. The extended PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) trial evaluated the >10-year clinical outcomes in patients with LMCA disease randomized to undergo PCI with drug-eluting stents (n = 300) or CABG (n = 300). The primary outcome was major adverse cardiac or cerebrovascular events (MACCE) (composite of death, myocardial infarction, stroke, or ischemia-driven target vessel revascularization) at 10 years. Of the 600 patients, 459 (76.5%) were male. The 10-year rates of MACCE were similar between male and female subjects in the overall cohort (27.3% vs 27.0%; adjusted hazard ratio [aHR]: 1.06; 95% confidence interval [CI]: 0.70-1.59), the PCI arm (30.6% vs 27.1%; aHR: 1.19; 95% CI: 0.69-2.05), and the CABG arm (24.0% vs 26.9%; aHR: 0.93; 95% CI: 0.53-1.62). The 10-year risks for MACCE did not significantly differ between PCI and CABG in both male (aHR: 1.37; 95% CI: 0.95-1.97) and female (aHR: 1.07; 95% CI: 0.56-2.07) subjects. There was no significant sex–treatment interaction regarding the adjusted risk of MACCE at 10 years (P for interaction = 0.52). In this 10-year follow-up of the PRECOMBAT trial, there was no sex-related impact on the long-term risk of MACCE after PCI and CABG for LMCA disease. (Ten-Year Outcomes of PRECOMBAT Trial; NCT03871127)
No takes yet. Share an insight, caveat, or question.
Yang et al. (2021) conducted an RCT in Unprotected left main coronary artery (LMCA) disease (n=600). Male sex vs. Female sex was evaluated on Major adverse cardiac or cerebrovascular events (MACCE) at 10 years (aHR 1.06, 95% CI 0.70-1.59, p=0.78). Male sex was not associated with a significantly different 10-year risk of major adverse cardiac or cerebrovascular events compared to female sex in patients with left main coronary artery disease (27.3% vs 27.0%; aHR 1.06), with no significant sex-treatment interaction.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: