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

Margaret B. McEntegart; Niels R. Holm; Martin M. Lindsay; Keith G. Oldroyd; Timo Mäkikallio; David Hildick-Smith; Andrejs Erglis; Thomas Kellerth; Giedrius Davidavicius; Ian B. A. Menown; Lone J. H. Mogensen; Per H. Nielsen; Terje K. Steigen; Petter C. Endresen; Mark S. Spence; Alastair N. J. Graham; Peteris Stradins; Vesa Anttila; Leif Thuesen; Evald H. Christiansen; NOBLE study investigators

doi:10.1016/j.jscai.2022.100338

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

Margaret B. McEntegart^*, Niels R. Holm, Martin M. Lindsay, Keith G. Oldroyd, Timo Mäkikallio, David Hildick-Smith, Andrejs Erglis, Thomas Kellerth, Giedrius Davidavicius, Ian B. A. Menown, Lone J. H. Mogensen, Per H. Nielsen, Terje K. Steigen, Petter C. Endresen, Mark S. Spence, Alastair N. J. Graham, Peteris Stradins, Vesa Anttila, Leif Thuesen, Evald H. ChristiansenNOBLE study investigators

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

Background
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.

Methods
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.

Results
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.

Conclusions
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.

Original language	English
Article number	100338
Journal	Journal of the Society for Cardiovascular Angiography & Interventions
Volume	1
Issue number	4
ISSN	2772-9303
DOIs	https://doi.org/10.1016/j.jscai.2022.100338
Publication status	Published - Jul 2022

Bibliographical note

Publisher Copyright:
© 2022 The Authors

Keywords

coronary artery bypass surgery
Female
left main coronary artery disease
percutaneous coronary intervention

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McEntegart et al. (2023). Sex-Specific Clinical Outcomes After Treatment of Left Main Coronary Artery Disease. A NOBLE SubstudyFinal published version, 779 KBLicence: CC BY 4.0

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McEntegart, M. B., Holm, N. R., Lindsay, M. M., Oldroyd, K. G., Mäkikallio, T., Hildick-Smith, D., Erglis, A., Kellerth, T., Davidavicius, G., Menown, I. B. A., Mogensen, L. J. H., Nielsen, P. H., Steigen, T. K., Endresen, P. C., Spence, M. S., Graham, A. N. J., Stradins, P., Anttila, V., Thuesen, L., ... NOBLE study investigators (2022). Sex-Specific Clinical Outcomes After Treatment of Left Main Coronary Artery Disease. A NOBLE Substudy. Journal of the Society for Cardiovascular Angiography & Interventions, 1(4), Article 100338. https://doi.org/10.1016/j.jscai.2022.100338

@article{927e092c50b64e4ca1ed0da713c174c0,

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

abstract = "BackgroundWhile 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.MethodsNordic-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.ResultsOf 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.ConclusionsFollowing 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.",

keywords = "coronary artery bypass surgery, Female, left main coronary artery disease, percutaneous coronary intervention",

author = "McEntegart, {Margaret B.} and Holm, {Niels R.} and Lindsay, {Martin M.} and Oldroyd, {Keith G.} and Timo M{\"a}kikallio and David Hildick-Smith and Andrejs Erglis and Thomas Kellerth and Giedrius Davidavicius and Menown, {Ian B. A.} and Mogensen, {Lone J. H.} and Nielsen, {Per H.} and Steigen, {Terje K.} and Endresen, {Petter C.} and Spence, {Mark S.} and Graham, {Alastair N. J.} and Peteris Stradins and Vesa Anttila and Leif Thuesen and Christiansen, {Evald H.} and {NOBLE study investigators}",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = jul,

doi = "10.1016/j.jscai.2022.100338",

language = "English",

volume = "1",

journal = "Journal of the Society for Cardiovascular Angiography & Interventions",

issn = "2772-9303",

publisher = "Elsevier",

number = "4",

}

McEntegart, MB, Holm, NR, Lindsay, MM, Oldroyd, KG, Mäkikallio, T, Hildick-Smith, D, Erglis, A, Kellerth, T, Davidavicius, G, Menown, IBA, Mogensen, LJH, Nielsen, PH, Steigen, TK, Endresen, PC, Spence, MS, Graham, ANJ, Stradins, P, Anttila, V, Thuesen, L, Christiansen, EH & NOBLE study investigators 2022, 'Sex-Specific Clinical Outcomes After Treatment of Left Main Coronary Artery Disease. A NOBLE Substudy', Journal of the Society for Cardiovascular Angiography & Interventions, vol. 1, no. 4, 100338. https://doi.org/10.1016/j.jscai.2022.100338

TY - JOUR

T1 - Sex-Specific Clinical Outcomes After Treatment of Left Main Coronary Artery Disease. A NOBLE Substudy

AU - McEntegart, Margaret B.

AU - Holm, Niels R.

AU - Lindsay, Martin M.

AU - Oldroyd, Keith G.

AU - Mäkikallio, Timo

AU - Hildick-Smith, David

AU - Erglis, Andrejs

AU - Kellerth, Thomas

AU - Davidavicius, Giedrius

AU - Menown, Ian B. A.

AU - Mogensen, Lone J. H.

AU - Nielsen, Per H.

AU - Steigen, Terje K.

AU - Endresen, Petter C.

AU - Spence, Mark S.

AU - Graham, Alastair N. J.

AU - Stradins, Peteris

AU - Anttila, Vesa

AU - Thuesen, Leif

AU - Christiansen, Evald H.

AU - NOBLE study investigators

PY - 2022/7

Y1 - 2022/7

N2 - BackgroundWhile 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.MethodsNordic-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.ResultsOf 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.ConclusionsFollowing 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.

AB - BackgroundWhile 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.MethodsNordic-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.ResultsOf 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.ConclusionsFollowing 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.

KW - coronary artery bypass surgery

KW - Female

KW - left main coronary artery disease

KW - percutaneous coronary intervention

UR - http://www.scopus.com/inward/record.url?scp=85160549208&partnerID=8YFLogxK

U2 - 10.1016/j.jscai.2022.100338

DO - 10.1016/j.jscai.2022.100338

M3 - Journal article

AN - SCOPUS:85160549208

SN - 2772-9303

VL - 1

JO - Journal of the Society for Cardiovascular Angiography & Interventions

JF - Journal of the Society for Cardiovascular Angiography & Interventions

IS - 4

M1 - 100338

ER -

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

Abstract

Bibliographical note

Keywords

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