1
|
McEntegart MB, Holm NR, Lindsay MM, Oldroyd KG, Mäkikallio T, Hildick-Smith D, Erglis A, Kellerth T, Davidavicius G, Menown IB, Mogensen LJ, Nielsen PH, Steigen TK, Endresen PC, Spence MS, Graham AN, Stradins P, Anttila V, Thuesen L, Christiansen EH. Sex-Specific Clinical Outcomes After Treatment of Left Main Coronary Artery Disease. A NOBLE Substudy. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100338. [PMID: 39131931 PMCID: PMC11308852 DOI: 10.1016/j.jscai.2022.100338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 08/13/2024]
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.
Collapse
Affiliation(s)
- Margaret B. McEntegart
- Department of Cardiology, Golden Jubilee National Hospital, University of Glasgow, Glasgow, United Kingdom
| | - Niels R. Holm
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Martin M. Lindsay
- Department of Cardiology, Golden Jubilee National Hospital, University of Glasgow, Glasgow, United Kingdom
| | - Keith G. Oldroyd
- Department of Cardiology, Golden Jubilee National Hospital, University of Glasgow, Glasgow, United Kingdom
| | - Timo Mäkikallio
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, United Kingdom
| | - Andrejs Erglis
- Latvia Centre of Cardiology, Paul Stradins Clinical Hospital, Riga, Latvia
| | - Thomas Kellerth
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | - Giedrius Davidavicius
- Clinic of Cardiac and Vascular Disease, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Ian B.A. Menown
- Department of Cardiology, Craigavon Cardiac Centre, Craigavon, Northern Ireland
| | - Lone J.H. Mogensen
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Per H. Nielsen
- Department of Cardiac Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Terje K. Steigen
- Cardiovascular Research Group, Department of Cardiology, UiT The Arctic University of Norway, University Hospital of North Norway, Tromsø, Norway
| | - Petter C. Endresen
- Department of Cardiovascular Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Mark S. Spence
- Belfast Heart Centre, Belfast Trust, Belfast, Northern Ireland
| | - Alastair N.J. Graham
- Department of Thoracic Surgery, Belfast Heart Centre, Belfast Trust, Belfast, Northern Ireland
| | - Peteris Stradins
- Department of Thoracic Surgery, Latvia Centre of Cardiology, Paul Stradins Clinical Hospital, Riga, Latvia
| | - Vesa Anttila
- Department of Cardiac Surgery, Oulu University Hospital, Oulu, Finland
| | - Leif Thuesen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - NOBLE Study Investigators
- Department of Cardiology, Golden Jubilee National Hospital, University of Glasgow, Glasgow, United Kingdom
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, United Kingdom
- Latvia Centre of Cardiology, Paul Stradins Clinical Hospital, Riga, Latvia
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
- Clinic of Cardiac and Vascular Disease, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Department of Cardiology, Craigavon Cardiac Centre, Craigavon, Northern Ireland
- Department of Cardiac Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
- Cardiovascular Research Group, Department of Cardiology, UiT The Arctic University of Norway, University Hospital of North Norway, Tromsø, Norway
- Department of Cardiovascular Surgery, University Hospital of North Norway, Tromsø, Norway
- Belfast Heart Centre, Belfast Trust, Belfast, Northern Ireland
- Department of Thoracic Surgery, Belfast Heart Centre, Belfast Trust, Belfast, Northern Ireland
- Department of Thoracic Surgery, Latvia Centre of Cardiology, Paul Stradins Clinical Hospital, Riga, Latvia
- Department of Cardiac Surgery, Oulu University Hospital, Oulu, Finland
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
2
|
Alasnag M, Ahmed W, Al-Bawardy R, Shammeri OA, Biswas S, Johnson TW. Optimising PCI by Intracoronary Image-guidance. Front Cardiovasc Med 2022; 9:878801. [PMID: 35647055 PMCID: PMC9136172 DOI: 10.3389/fcvm.2022.878801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Evidence to support the use of intracoronary imaging (ICI) in guiding percutaneous coronary intervention (PCI) is growing, with observational and randomized controlled trials demonstrating a benefit in acute procedural and clinical outcomes. ICI provides an opportunity to guide PCI, detailing the nature of the coronary disease, potentially influencing lesion preparation and stent selection. Following stent deployment, ICI offers a detailed assessment of lesion coverage, associated vessel trauma and stent expansion. Consensus statements have emphasized the role of ICI and detailed the parameters of stent optimization. However, intracoronary imaging is not adopted widely yet. Significant global differences in the uptake of ICI have been reported, with the vast majority of PCI being angiographically-guided. The three major barriers to the implementation of ICI include, in order of impact, prohibitive cost, prolongation of procedure time and local regulatory issues for use. However, it is our belief that a lack of education and the associated challenges of ICI interpretation provide the greatest barrier to adoption. We hope that this review of the role of ICI in PCI optimization will provide a platform for PCI operators to gain confidence in the utilization of ICI to enhance outcomes for their patients.
Collapse
Affiliation(s)
- Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
- *Correspondence: Mirvat Alasnag
| | - Waqar Ahmed
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Rasha Al-Bawardy
- King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | | | - Sinjini Biswas
- Bristol Heart Institute, Translational Health Science, University of Bristol, Bristol, United Kingdom
| | - Thomas W. Johnson
- Bristol Heart Institute, Translational Health Science, University of Bristol, Bristol, United Kingdom
| |
Collapse
|