Abstract 4120534: Long-Term Outcomes After Medication, Coronary Stenting or Surgery for Men and Women With Three-Vessel Coronary Disease

Background: Sex is a vital prognostic factor in patients with coronary heart disease, however, the data on sex-treatment interaction among real-world patients with three-vessel coronary disease (TVD) are limited. Objectives: This study aimed to investigate the long-term outcomes after medication therapy (MT), percutaneous coronary intervention (PCI), and coronary artery bypass grafting surgery (CABG) according to sex in patients with TVD. Methods: Consecutive 8943 patients with TVD [2421 (27.1%) MT, 3825 (42.8%) PCI, and 2697 (30.2%) CABG] were enrolled from April 2004 to February 2011 at Fu Wai Hospital. The primary endpoint was cardiac death and major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction (MI), stroke or repeat revascularization. The secondary endpoints were the components of MACCE. Results: Among 8943 TVD patients, 7122 (79.6%) were men and 1821 (20.4%) were women. While the number of women undergoing PCI was comparable to men, women opted for more MT and fewer CABG (Figure 1). During a median 6.6-year follow-up, CABG showed a lower risk of MACCE compared to PCI, with a similar treatment effect for women and men (female HR: 0.76; 95% CI: 0.60 to 0.97; male HR: 0.61, 95% CI: 0.55 to 0.69; p for interaction=0.222) (Figure 2 and Figure 3). CABG also showed lower risks of all-cause death, MI, and repeat revascularization, and a higher risk of stroke, which had no significant interaction with sex. PCI, compared to MT, was associated with lower risks of MACCE, all-cause death, and stroke and a higher risk of MI and repeat revascularization, without significant gender disparities. CABG versus MT was associated with lower risks of MACCE, all-cause death, MI and repeat revascularization and a higher risk of stroke, with a similar treatment effect for female and male patients (Figure 3). Conclusion: There was no significant sex differences in the risks of long-term outcomes of PCI vs. CABG, PCI vs. MT, and CABG vs. MT in real-world TVD patients.