Interaction Between Treatment and Age or Sex in Non-ST-Segment Elevation Acute Coronary Disease and Three-Vessel Disease

Frontiers in Cardiovascular Medicine

Lianjun Xu¹  Lei Song¹  Runlin Gao¹  Xueyan Zhao¹  Jian Tian¹  Jinqing Yuan¹  Rutai Hui¹  Dong Wang¹  Lin Jiang¹  Jingjing Xu¹  Ru Liu¹  Yin Zhang¹  Bo Xu¹  Xinxing Feng²  Kai Sun³  Wei Zhao³  Tianyu Li⁴ 

[1] Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;Department of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;Information Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;National Clinical Research Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;

关键词: non-ST-segment elevation acute coronary syndrome;    three-vessel disease;    coronary artery bypass grafting;    percutaneous coronary intervention;    age;    sex;   

DOI  :  10.3389/fcvm.2022.879834

来源: DOAJ

【 摘 要 】

AimsTo explore the effects of age and sex on the outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with the three-vessel disease (TVD).Methods and ResultsThe study is a subanalysis of data from a prospective cohort of 8,943 patients with angiographically confirmed TVD at Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China. The primary end point was major adverse cardiac and cerebrovascular events (MACCEs), a composite of all-cause death, myocardial infarction, and stroke. In total, 2,819 patients with NSTE-ACS who received CABG (43.6%) or PCI (56.4%) were included, among whom 32.7% were of 65–74 years, 7.2% were ≥75 years, and 22.6% were women. The median follow-up duration was 6.8 years. The superiority of CABG relative to PCI in terms of MACCE was decreased with age (adjusted hazard ratio [HR] [95% confidence interval (CI)]: <65 years: 0.662 [0.495–0.885], p = 0.005; 65–74 years: 0.700 [0.512–0.956], p = 0.025; ≥75 years: 0.884 [0.529–1.479], p = 0.640) and was only seen in men (adjusted HR [95% CI]: men: 0.668 [0.526–0.848], p = 0.001; women: 0.713 [0.505–1.006], p = 0.054). Significant treatment-by-sex and treatment-by-age interactions were observed in patients ≥ 75 years and women, respectively, (pinteraction with sex = 0.001; pinteraction with age = 0.002).ConclusionCoronary artery bypass grafting is favorable for most NSTE-ACS patients with TVD. The preponderance of CABG over PCI disappeared in patients ≥ 75 years and women. PCI is superior in women ≥ 75 years.

【 授权许可】

Unknown