Women with chronic coronary artery disease: long-term outcomes after percutaneous coronary intervention vs coronary artery bypass grafting

Background and aims — Real-world evidence comparing percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) in women with chronic severe coronary artery disease (CAD) is limited. This study aimed to compare long-term outcomes of PCI and CABG in women with chronic severe CAD.

Methods — This propensity score-matched retrospective cohort study linked clinical and administrative databases in Ontario, Canada to identify women with chronic severe CAD undergoing PCI or CABG from 2012 to 2021. Major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of all-cause mortality, myocardial infarction (MI), stroke, or repeat revascularization, as well as the individual components of MACCE and cardiovascular readmission (MI, heart failure [HF], or stroke), were evaluated using the Cox proportional hazards model.

Results — A total of 2469 and 3721 women underwent PCI and CABG, respectively. After propensity score matching, 2033 well-balanced pairs were identified. The mean (±SD) age of patients was 66.5 (±8.6) years. At a median follow-up of 5.1 (inter-quartile range: 2.9–7.5) years, MACCE was higher with PCI compared with CABG (hazard ratio [HR] 1.81, 95% confidence interval [CI]: 1.63–2.01], P < .001). All-cause mortality was higher with PCI compared with CABG (HR 1.34 [95% CI: 1.16–1.54], P < .001). Cardiovascular readmission (MI, HF, or stroke) was higher with PCI compared with CABG (HR 1.40 [95% CI: 1.32–1.49], P < .001).

Conclusions — In women with chronic severe CAD, CABG appears to be associated with a long-term reduction in MACCE and all-cause mortality compared with PCI. These findings support consideration of CABG as the preferred revascularization strategy in appropriately selected women.