Interventional Cardiology - CHIP/CTO Fellow Mass General Brigham Ottawa, Ontario, Canada
Background: Percutaneous coronary intervention (PCI) is the primary reperfusion strategy in ST-Elevation MI (STEMI). However, coronary artery bypass grafting (CABG) continues to play an essential role in the revascularization of STEMI patients who have complex coronary anatomy, non-culprit residual severe disease or those for whom PCI is unsuccessful. Women who present with STEMI and undergo CABG during their index admission form a small, understudied subgroup. We compared sex specific baseline, procedural, and outcome data for patients with STEMI who underwent CABG during their index hospitalization.
METHODS AND RESULTS: The Ottawa Heart Institute STEMI-PCI registry (2004-2018) was reviewed for patients who underwent CABG during their index STEMI hospitalization. Clinical variables were extracted retrospectively; sex was self-identified. Continuous data are mean ± SD, categorical data n (%); two-sample t-test or χ² were used as appropriate. Of the 5,904 patients in our primary PCI registry, 1,594 (27.0%) were women and 4,310 (73.0%) were men (Table). In total, 263 (4.5%) STEMI patients underwent inpatient CABG during their index admission. Women were less likely to be treated with CABG when compared to men (2.9 % vs 5 %, p < 0.001). Women were older than men (69 ± 12.1 years vs 64 ± 10.3 years, p = 0.004). Other baseline demographics, including comorbidities, presentation vitals and Killip class, were similar in the two groups. Angiography showed comparable rates of left main (46.8% vs 43.1%) and three-vessel disease (68% vs 74%). Both groups underwent similar rates of pre-CABG PCI (31.9 % vs 31 %). Women waited longer from the time of presentation to CABG (12.2 ± 40 vs 5 ± 8 days, p = 0.016). Both groups had similar rates of internal mammary artery grafting (89.3% vs 88.9%) and multiple arterial grafts (23.4% vs. 35.6%, p = 0.10). Women had higher 30-day mortality (10.6% vs 3.2%, p = 0.03), one-year mortality (14.9% vs 5.6%, p = 0.03), and 1-year major adverse cardiovascular and cerebrovascular events (MACCE) (21.3% vs 9.7%, p = 0.03). Women also experienced more BARC CABG-related major bleeding (36.2 % vs 21.3 %, p = 0.03).
Conclusion: In this single-centre cohort of STEMI patients, women compared to men were less likely to be treated with surgical revascularization. Women who underwent CABG were older, waited longer for surgery and experienced higher 30-day and 1-year mortality, MACCE, and major bleeding. Prospective studies are warranted to confirm these sex-specific findings and to explore targeted strategies to improve outcomes in this high-risk population.
