Revascularization strategies for multivessel coronary artery disease based on sex and age

Author:

Sulaiman Samian12,Harik Lamia3,Merz C Noel Bairey4,Fremes Stephen E5,Masterson Creber Ruth6,Rong Lisa Q7,Alkhouli Mohamad2,Gaudino Mario3ORCID

Affiliation:

1. Division of Cardiology, West Virginia University , Morgantown, WV, USA

2. Department of Cardiovascular Disease, Mayo Clinic , Rochester, MN, USA

3. Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY, USA

4. Department of Cardiology, Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center , Los Angeles, CA, USA

5. Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, ON, Canada

6. Columbia University School of Nursing , New York, NY, USA

7. Department of Anesthesia, Weill Cornell Medicine , New York, NY, USA

Abstract

Abstract OBJECTIVES This study describes coronary revascularization strategies used by sex and age in the USA. METHODS A sex-stratified cohort study from the National Inpatient Sample from the Agency for Healthcare Research and Quality (USA) including patients admitted for coronary revascularization with primary or secondary diagnoses of chronic coronary syndrome or non-ST elevation myocardial infarction who underwent ≥3-vessel coronary artery bypass grafting or percutaneous coronary intervention from January 2019 to December 2020. The primary outcome was the use rate of coronary artery bypass grafting or multivessel percutaneous coronary intervention. Prespecified subgroups included age and non-ST elevation myocardial infarction. RESULTS Among 121 150 patients (21.7% women), there were no sex differences in age (women: 66.6 [66.5–66.7], men: 67.6 [67.5–67.7], standardized mean difference: 0.1) or non-ST elevation myocardial infarction incidence (women: 37.4%, men: 45.7%, standardized mean difference: 0.17). The majority of women (74.2%) and men (84.9%) underwent bypass grafting, which was unaffected by age, race or non-ST elevation myocardial infarction. Women were less likely to undergo bypass grafting than percutaneous intervention (adjusted odds ratio 0.49, 95% confidence interval 0.44–0.54; P < 0.001) and a disparity most pronounced in patients >80 years old (adjusted odds ratio 0.31, 95% confidence interval 0.22–0.45; P < 0.001). CONCLUSIONS Most patients with multivessel coronary artery disease needing revascularization undergo bypass grafting, irrespective of sex, age or clinical presentation. The sex disparity in the use of bypass grafting is mostly seen among patients >80 years old.

Funder

National Institutes of Health

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,General Medicine,Surgery

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