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

TitleRevascularization strategies for multivessel coronary artery disease based on sex and age.
Publication TypeJournal Article
Year of Publication2023
AuthorsSulaiman S, Harik L, C Merz NBairey, Fremes SE, Creber RMasterson, Rong LQ, Alkhouli M, Gaudino M
JournalEur J Cardiothorac Surg
Date Published2023 Nov 01
KeywordsAged, 80 and over, Cohort Studies, Coronary Artery Bypass, Coronary Artery Disease, Female, Humans, Male, Myocardial Infarction, Percutaneous Coronary Intervention, Risk Factors, Treatment Outcome

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.

Alternate JournalEur J Cardiothorac Surg
PubMed ID37947309
PubMed Central IDPMC10641124
Grant List / NH / NIH HHS / United States
R01HL124649 / NH / NIH HHS / United States