Impact of gender on long-term mortality in patients with unprotected left main disease: The Milan and New-Tokyo (MITO) Registry

Kensuke Takagi, Alaide Chieffo, Joanne Shannon, Toru Naganuma, Satoko Tahara, Yusuke Fujino, Azeem Latib, Matteo Montorfano, Mauro Carlino, Hiroyoshi Kawamoto, Sunao Nakamura, Antonio Colombo

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Abstract

Background Although percutaneous intervention (PCI) for ULM is common, the impact of gender remains unclear. This study aimed to clarify the impact of gender in patients treated with drug-eluting stents (DES) for unprotected left main (ULM) disease. Methods Between April 2002 and August 2011, 1026 consecutive patients (212 women and 814 men) undergoing PCI using first or second generation DES for ULM stenosis were analyzed. Study endpoints included major adverse cardiac events (MACE) defined as composite of all-cause death, myocardial infarction (MI), and target lesion revascularization (TLR). Individual components of MACE and cardiac death were also evaluated. Results Women had greater comorbidity and more complex lesions, resulting in a higher incidence of cardiac death, TLR and MI {[HR, 1.94 (95% CI, 1.22–3.09, p = 0.005)], [HR, 1.31 (95% CI 0.96–1.81), p = 0.09] and [HR, 2.04 (95% CI, 0.98–4.25), p = 0.06], respectively}. Propensity score matching identified 131 matched pairs. There were no differences in MACE [HR, 1.04 (95% CI, 0.68–1.61, p = 0.85)], all-cause death [HR, 0.96 (95% CI, 0.52–1.77), p = 0.89] or MI [HR, 0.84 (95% CI, 0.21–3.50, p = 0.84)]. However, cardiac death [HR, 2.70 (95% CI, 0.98–7.49, p = 0.056] and TLR [HR, 1.62 (95% CI, 0.93–2.84), p = 0.09] showed a trend to being higher in women compared to men. Conclusions In patients with ULM disease, women had greater comorbidity and more complex lesions, resulting in an increased risk of clinical events. However after propensity matching, there was no difference in the occurrence of MACE but cardiac death showed a trend to being higher in women compared to men.

Original languageEnglish
Pages (from-to)369-374
Number of pages6
JournalCardiovascular Revascularization Medicine
Volume17
Issue number6
DOIs
Publication statusPublished - Sep 1 2016

Fingerprint

Tokyo
Registries
Mortality
Drug-Eluting Stents
Myocardial Infarction
Comorbidity
Cause of Death
Propensity Score
Pathologic Constriction
Incidence

Keywords

  • Drug-eluting stent
  • Gender difference
  • Unprotected left main coronary artery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of gender on long-term mortality in patients with unprotected left main disease : The Milan and New-Tokyo (MITO) Registry. / Takagi, Kensuke; Chieffo, Alaide; Shannon, Joanne; Naganuma, Toru; Tahara, Satoko; Fujino, Yusuke; Latib, Azeem; Montorfano, Matteo; Carlino, Mauro; Kawamoto, Hiroyoshi; Nakamura, Sunao; Colombo, Antonio.

In: Cardiovascular Revascularization Medicine, Vol. 17, No. 6, 01.09.2016, p. 369-374.

Research output: Contribution to journalArticle

Takagi, Kensuke ; Chieffo, Alaide ; Shannon, Joanne ; Naganuma, Toru ; Tahara, Satoko ; Fujino, Yusuke ; Latib, Azeem ; Montorfano, Matteo ; Carlino, Mauro ; Kawamoto, Hiroyoshi ; Nakamura, Sunao ; Colombo, Antonio. / Impact of gender on long-term mortality in patients with unprotected left main disease : The Milan and New-Tokyo (MITO) Registry. In: Cardiovascular Revascularization Medicine. 2016 ; Vol. 17, No. 6. pp. 369-374.
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title = "Impact of gender on long-term mortality in patients with unprotected left main disease: The Milan and New-Tokyo (MITO) Registry",
abstract = "Background Although percutaneous intervention (PCI) for ULM is common, the impact of gender remains unclear. This study aimed to clarify the impact of gender in patients treated with drug-eluting stents (DES) for unprotected left main (ULM) disease. Methods Between April 2002 and August 2011, 1026 consecutive patients (212 women and 814 men) undergoing PCI using first or second generation DES for ULM stenosis were analyzed. Study endpoints included major adverse cardiac events (MACE) defined as composite of all-cause death, myocardial infarction (MI), and target lesion revascularization (TLR). Individual components of MACE and cardiac death were also evaluated. Results Women had greater comorbidity and more complex lesions, resulting in a higher incidence of cardiac death, TLR and MI {[HR, 1.94 (95{\%} CI, 1.22–3.09, p = 0.005)], [HR, 1.31 (95{\%} CI 0.96–1.81), p = 0.09] and [HR, 2.04 (95{\%} CI, 0.98–4.25), p = 0.06], respectively}. Propensity score matching identified 131 matched pairs. There were no differences in MACE [HR, 1.04 (95{\%} CI, 0.68–1.61, p = 0.85)], all-cause death [HR, 0.96 (95{\%} CI, 0.52–1.77), p = 0.89] or MI [HR, 0.84 (95{\%} CI, 0.21–3.50, p = 0.84)]. However, cardiac death [HR, 2.70 (95{\%} CI, 0.98–7.49, p = 0.056] and TLR [HR, 1.62 (95{\%} CI, 0.93–2.84), p = 0.09] showed a trend to being higher in women compared to men. Conclusions In patients with ULM disease, women had greater comorbidity and more complex lesions, resulting in an increased risk of clinical events. However after propensity matching, there was no difference in the occurrence of MACE but cardiac death showed a trend to being higher in women compared to men.",
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T1 - Impact of gender on long-term mortality in patients with unprotected left main disease

T2 - The Milan and New-Tokyo (MITO) Registry

AU - Takagi, Kensuke

AU - Chieffo, Alaide

AU - Shannon, Joanne

AU - Naganuma, Toru

AU - Tahara, Satoko

AU - Fujino, Yusuke

AU - Latib, Azeem

AU - Montorfano, Matteo

AU - Carlino, Mauro

AU - Kawamoto, Hiroyoshi

AU - Nakamura, Sunao

AU - Colombo, Antonio

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background Although percutaneous intervention (PCI) for ULM is common, the impact of gender remains unclear. This study aimed to clarify the impact of gender in patients treated with drug-eluting stents (DES) for unprotected left main (ULM) disease. Methods Between April 2002 and August 2011, 1026 consecutive patients (212 women and 814 men) undergoing PCI using first or second generation DES for ULM stenosis were analyzed. Study endpoints included major adverse cardiac events (MACE) defined as composite of all-cause death, myocardial infarction (MI), and target lesion revascularization (TLR). Individual components of MACE and cardiac death were also evaluated. Results Women had greater comorbidity and more complex lesions, resulting in a higher incidence of cardiac death, TLR and MI {[HR, 1.94 (95% CI, 1.22–3.09, p = 0.005)], [HR, 1.31 (95% CI 0.96–1.81), p = 0.09] and [HR, 2.04 (95% CI, 0.98–4.25), p = 0.06], respectively}. Propensity score matching identified 131 matched pairs. There were no differences in MACE [HR, 1.04 (95% CI, 0.68–1.61, p = 0.85)], all-cause death [HR, 0.96 (95% CI, 0.52–1.77), p = 0.89] or MI [HR, 0.84 (95% CI, 0.21–3.50, p = 0.84)]. However, cardiac death [HR, 2.70 (95% CI, 0.98–7.49, p = 0.056] and TLR [HR, 1.62 (95% CI, 0.93–2.84), p = 0.09] showed a trend to being higher in women compared to men. Conclusions In patients with ULM disease, women had greater comorbidity and more complex lesions, resulting in an increased risk of clinical events. However after propensity matching, there was no difference in the occurrence of MACE but cardiac death showed a trend to being higher in women compared to men.

AB - Background Although percutaneous intervention (PCI) for ULM is common, the impact of gender remains unclear. This study aimed to clarify the impact of gender in patients treated with drug-eluting stents (DES) for unprotected left main (ULM) disease. Methods Between April 2002 and August 2011, 1026 consecutive patients (212 women and 814 men) undergoing PCI using first or second generation DES for ULM stenosis were analyzed. Study endpoints included major adverse cardiac events (MACE) defined as composite of all-cause death, myocardial infarction (MI), and target lesion revascularization (TLR). Individual components of MACE and cardiac death were also evaluated. Results Women had greater comorbidity and more complex lesions, resulting in a higher incidence of cardiac death, TLR and MI {[HR, 1.94 (95% CI, 1.22–3.09, p = 0.005)], [HR, 1.31 (95% CI 0.96–1.81), p = 0.09] and [HR, 2.04 (95% CI, 0.98–4.25), p = 0.06], respectively}. Propensity score matching identified 131 matched pairs. There were no differences in MACE [HR, 1.04 (95% CI, 0.68–1.61, p = 0.85)], all-cause death [HR, 0.96 (95% CI, 0.52–1.77), p = 0.89] or MI [HR, 0.84 (95% CI, 0.21–3.50, p = 0.84)]. However, cardiac death [HR, 2.70 (95% CI, 0.98–7.49, p = 0.056] and TLR [HR, 1.62 (95% CI, 0.93–2.84), p = 0.09] showed a trend to being higher in women compared to men. Conclusions In patients with ULM disease, women had greater comorbidity and more complex lesions, resulting in an increased risk of clinical events. However after propensity matching, there was no difference in the occurrence of MACE but cardiac death showed a trend to being higher in women compared to men.

KW - Drug-eluting stent

KW - Gender difference

KW - Unprotected left main coronary artery

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