Prognosis in 10 years of follow-up of three therapeutic strategies for chronic multivessel coronary artery disease in women (study MASS)

Abstract

Studies were contradictory regarding increased mortality in women undergoing coronary interventions. The worst prognosis in women was justified by aging, body mass index and more comorbidity. The aim of this study was to analyze the long-term prognosis of each therapeutic strategy, Coronary Artery Bypass Graft (CABG), Percutaneous Coronary Intervention (PCI) and Medical Treatment (MT) in men and women. Methods: A prospective 10-year follow-up study randomized 1084 patients with stable chronic CAD for MT (N=324, 30%), PCI (N=306, 28%) or CABG (N=454, 42%). The number of women for each strategy was respectively: 100 (9%), 97 (9%) and 116 (10%). CAD was defined by the presence of angina pectoris CCS class II and III, positive exercise stress testing, ejection fraction >40% and ≥2 coronary lesions >70%. Primary outcomes were incidence of total mortality, Q-MI, or refractory angina that required revascularization. All data were analyzed according to the intention-to-treat principle. Results: Women had a higher number of primary events with the CABG strategy (p=0.002) and similar to the MT (p=0.902) and ICP (p=0.465), however the CABG was the best therapeutic strategy in women (Figure 1). To death, no differences were observed for both sexes in all strategies (Figure 2). In multivariate Cox regression sex was not an independent variable for each strategy for both primary events and death. For primary events independent variables for poor outcome for each strategy were: PCI, diabetes (p = 0.030); MT, hypertension (p=0.006); CABG, age (p<0.001). To death, were: PCI, no variable; MT, age (p=0.011) and diabetes (p=0.030); CABG, age (p<0.001). ![Figure][1] Conclusion: CABG was the best treatment strategy in women despite the higher number of primary events compared with men. [1]: pending:yes