Sex-Specific Clinical Outcomes After Treatment of Left Main Coronary Artery Disease. A NOBLE Substudy

• Published in: Journal of the Society for Cardiovascular Angiography & Interventions 2022-07, Vol.1 (4), p.100338, Article 100338
• Main Authors: McEntegart, Margaret B., Holm, Niels R., Lindsay, Martin M., Oldroyd, Keith G., Mäkikallio, Timo, Hildick-Smith, David, Erglis, Andrejs, Kellerth, Thomas, Davidavicius, Giedrius, Menown, Ian B.A., Mogensen, Lone J.H., Nielsen, Per H., Steigen, Terje K., Endresen, Petter C., Spence, Mark S., Graham, Alastair N.J., Stradins, Peteris, Anttila, Vesa, Thuesen, Leif, Christiansen, Evald H.
• Format: Article
• Language: English
• Subjects: coronary artery bypass surgery; Female; left main coronary artery disease; percutaneous coronary intervention
• ISSN: 2772-9303; 2772-9303
• DOI: 10.1016/j.jscai.2022.100338

While female sex has been associated with worse outcomes following coronary revascularization, previous analyses in left main coronary artery (LMCA) disease have been conflicting. In addition, a signal that increased mortality may be specific to women treated with percutaneous coronary intervention (PCI) requires further investigation. Nordic-Baltic-British left main revascularization study (NOBLE) was a randomized trial comparing PCI to coronary artery bypass surgery (CABG) in patients with LMCA disease. The primary endpoint was a composite of all-cause mortality, nonprocedural myocardial infarction, repeat revascularization, and stroke (major adverse cardiovascular and cerebrovascular events [MACCE]). We report the 5-year sex-specific outcomes. Of 1184 patients analyzed, 256 (22%) were female and 928 (78%) were male. There were no significant within-sex differences in baseline characteristics, disease location, or complexity between those treated with PCI and those with CABG. The 5-year MACCE rates were 29% and 15% in females and 28% and 20% in males treated with PCI and CABG, respectively. Within both sexes, there was an increased risk of MACCE with PCI compared with CABG, but no difference in all-cause mortality. On multivariate analysis, female sex was not an independent predictor of MACCE. Following the treatment of LMCA disease, long-term outcomes favored CABG over PCI in both sexes. Importantly, there was no difference in all-cause mortality in females or males at 5 ​years. [Display omitted] •There was no difference in 5-year mortality with CABG compared with PCI in both sexes.•There was more MACCE at 5 years with PCI than CABG in both sexes.•Female sex was not an independent predictor of 5-year MACCE.