In the Journals

EXCEL: PCI in women, CABG in men may confer worse outcomes after left main revascularization

Patrick W. Serruys

Among patients with unprotected left main disease, sex was not an independent predictor of adverse outcomes after revascularization, according to new data from the EXCEL trial.

The results, however, showed a trend toward worse outcomes among women undergoing PCI and among men undergoing CABG, which was linked to comorbidities and increased periprocedural complications.

“In patients with multivessel disease and/or [unprotected left main disease], sex has been shown to be an important factor to be considered in the decision-making process of selecting the revascularization strategy,” Patrick W. Serruys, MD, PhD, from Imperial College London, and colleagues wrote in the study. “Sex differences have never been studied in a large dedicated randomized trial of patients with [unprotected left main disease].”

As Cardiology Today’s Intervention previously reported, in the main results of the 1,905-patient EXCEL trial, patients with left main CAD and low or intermediate SYNTAX scores had similar outcomes regardless of whether they underwent CABG or PCI with an everolimus-eluting stent (Xience, Abbott Vascular). The primary endpoint was a composite of all-cause death, MI, or stroke at 3 years.

For the present analysis, Serruys and colleagues compared outcomes between men (76.9%) and women (23.1%).

According to the results, women were older and had higher prevalence rates of hypertension, hyperlipidemia and diabetes and were less commonly smokers but had lower coronary anatomic burden and complexity compared with men (mean SYNTAX score, 24.2 vs. 27.2, P < .001).

According to a multivariate analysis, there was no independent association between sex and the primary endpoint (HR = 1.1; 95% CI, 0.82-1.48) or all-cause death (HR = 1.39; 95% CI, 0.92-2.1) at 3 years.

The researchers found that all-cause death, MI, or stroke had occurred in 8.9% of women treated with PCI, 6.2% of women treated with CABG, 3.6% of men treated with PCI and 8.4% of men treated with CABG at 30 days (P for interaction = .003).

The 3-year rate of the composite primary endpoint was 19.7% in women treated with PCI, 14.6% in women treated with CABG, 13.8% in men treated with PCI, and 14.7% in men treated with CABG, according to Serruys and colleagues (P for interaction = .06). According to the researchers, these differences were driven by higher periprocedural rates of MI in women after PCI and in men after CABG.

“In the present study of patients with [unprotected left main disease] undergoing contemporary PCI and CABG, women undergoing PCI had a trend toward worse outcomes at 3 years, a finding related to associated comorbidities and greater procedural complications,” the researchers wrote. “These findings confirm sex-specific outcomes in patients with [unprotected left main disease] undergoing myocardial revascularization.” by Dave Quaile

Disclosures: Serruys reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Patrick W. Serruys

Among patients with unprotected left main disease, sex was not an independent predictor of adverse outcomes after revascularization, according to new data from the EXCEL trial.

The results, however, showed a trend toward worse outcomes among women undergoing PCI and among men undergoing CABG, which was linked to comorbidities and increased periprocedural complications.

“In patients with multivessel disease and/or [unprotected left main disease], sex has been shown to be an important factor to be considered in the decision-making process of selecting the revascularization strategy,” Patrick W. Serruys, MD, PhD, from Imperial College London, and colleagues wrote in the study. “Sex differences have never been studied in a large dedicated randomized trial of patients with [unprotected left main disease].”

As Cardiology Today’s Intervention previously reported, in the main results of the 1,905-patient EXCEL trial, patients with left main CAD and low or intermediate SYNTAX scores had similar outcomes regardless of whether they underwent CABG or PCI with an everolimus-eluting stent (Xience, Abbott Vascular). The primary endpoint was a composite of all-cause death, MI, or stroke at 3 years.

For the present analysis, Serruys and colleagues compared outcomes between men (76.9%) and women (23.1%).

According to the results, women were older and had higher prevalence rates of hypertension, hyperlipidemia and diabetes and were less commonly smokers but had lower coronary anatomic burden and complexity compared with men (mean SYNTAX score, 24.2 vs. 27.2, P < .001).

According to a multivariate analysis, there was no independent association between sex and the primary endpoint (HR = 1.1; 95% CI, 0.82-1.48) or all-cause death (HR = 1.39; 95% CI, 0.92-2.1) at 3 years.

The researchers found that all-cause death, MI, or stroke had occurred in 8.9% of women treated with PCI, 6.2% of women treated with CABG, 3.6% of men treated with PCI and 8.4% of men treated with CABG at 30 days (P for interaction = .003).

The 3-year rate of the composite primary endpoint was 19.7% in women treated with PCI, 14.6% in women treated with CABG, 13.8% in men treated with PCI, and 14.7% in men treated with CABG, according to Serruys and colleagues (P for interaction = .06). According to the researchers, these differences were driven by higher periprocedural rates of MI in women after PCI and in men after CABG.

“In the present study of patients with [unprotected left main disease] undergoing contemporary PCI and CABG, women undergoing PCI had a trend toward worse outcomes at 3 years, a finding related to associated comorbidities and greater procedural complications,” the researchers wrote. “These findings confirm sex-specific outcomes in patients with [unprotected left main disease] undergoing myocardial revascularization.” by Dave Quaile

Disclosures: Serruys reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.