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

Frontiers in Cardiovascular Medicine

article

Tianyu Li¹  Lin Jiang²  Lianjun Xu²  Jian Tian²  Xueyan Zhao²  Xinxing Feng³  Dong Wang²  Yin Zhang²  Kai Sun⁴  Jingjing Xu²  Ru Liu²  Bo Xu²  Wei Zhao⁴  Rutai Hui²  Runlin Gao²  Lei Song¹  Jinqing Yuan¹ 

[1] 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;Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College;Department of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College;Information Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

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

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Aims To 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 Results The 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, ( p interaction with sex = 0.001; p interaction with age = 0.002). Conclusion Coronary 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】

CC BY