Effect of Age and Sex on Outcomes After Stenting or Bypass Surgery in Left Main Coronary Artery Disease

Abstract

Age and sex contribute to determining coronary revascularization strategies for patients with left main coronary artery (LMCA) disease. We examined age- and sex-related differences in comparative outcomes after percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG) for LMCA disease. A total of 4,001 patients with LMCA disease (men, n = 3,100, women, n = 901) who underwent PCI (n = 2,615) or CABG (n = 1,386) from the Interventional Research Incorporation Society-Left MAIN Revascularization registry were analyzed. Patients were stratified into subgroups according to the tertiles of age (<60 years, 60 to 69 years, and ≥70 years) and sex. The primary outcome was the composite of death from any cause, myocardial infarction, or stroke. During the median 6.3 years of follow-up, the adjusted risks for primary outcome after PCI relative to CABG were similar in patients aged <60 years (hazard ratio [HR]: 0.64, 95% confidence interval [CI]: 0.35 to 1.16), 60 to 69 years (HR: 1.21; 95% CI: 0.82 to 1.80), and ≥70 years (HR: 0.90; 95% CI: 0.66 to 1.22) with no significant age-related interactions (P_interaction = 0.57). The primary outcome risks following PCI versus CABG were similar between male (HR: 0.92; 95% CI: 0.72 to 1.17) and female (HR: 0.89; 95% CI: 0.52 to 1.50) (P_interaction = 0.65). Significant interactions were absent for age or sex and revascularization type for all-cause mortality (P_interaction = 0.34 for age and P_interaction = 0.99 for sex), repeat revascularization (P_interaction = 0.10 for age and P_interaction = 0.65 for sex), and major adverse cardiac or cerebrovascular events (P_interaction = 0.29 for age and P_interaction = 0.30 for sex). In conclusion, there were no significant age- or sex-related differences in comparative outcomes after PCI or CABG for LMCA disease.