Coronary Artery Bypass Surgery vs. Percutaneous Interventions for Women with Multivessel Coronary Artery Disease

Abstract

ObjectiveTo compare outcomes in women undergoing percutaneous coronary intervention and coronary artery bypass graft surgery. DesignRetrospective, propensity-score matched cohort study from the New York State cardiac registry (2012-2018) of all women with multivessel coronary artery disease undergoing percutaneous coronary intervention with everolimus-eluting stents and coronary artery bypass graft surgery. The primary outcome was all-cause mortality. The key secondary outcome was major adverse cardiac events, defined as the composite of all-cause mortality, myocardial infarction, and stroke. ResultsPercutaneous coronary intervention with everolimus-eluting stents was associated with a higher six-year risk of mortality (25.75% vs. 23.57%; adjusted hazard ratio=1.29, 95% confidence interval 1.14, 1.45). Percutaneous intervention was also associated with a higher rate of the composite of death, myocardial infarction, and stroke (36.58% vs. 32.89%, adjusted hazard ratio=1.28, 95% confidence interval 1.17, 1.41), as well as myocardial infarction (14.94% vs. 9.12%, adjusted hazard ratio=1.84, 95% confidence interval: 1.56, 2.17), but not stroke (7.07% vs. 7.62%, adjusted hazard ratio=0.83, 95% confidence interval: 0.67, 1.03). Repeat revascularization rates were also higher for women undergoing percutaneous coronary intervention (21.53% vs. 11.57%, adjusted hazard ratio=1.88, 95% confidence interval: 1.63, 2.17). There was no mortality difference between the two interventions when percutaneous coronary intervention patients received complete revascularization, or had non-complex lesions, and for women without diabetes. ConclusionsFor women with multivessel coronary artery disease, coronary artery bypass graft surgery is associated with lower six-year mortality, myocardial infarction, and repeat revascularization rates in comparison to percutaneous coronary intervention with everolimus-eluting stents.