(CCSP124) SEX-DIFFERENCES IN 5 YEAR SURVIVAL WITH PERCUTANEOUS CORONARY INTERVENTION COMPARED TO CORONARY ARTERY BYPASS GRAFT SURGERY IN PATIENTS WITH DIABETES AND MULTIVESSEL DISEASE

Background: Coronary artery bypass graft (CABG) surgery is preferred over percutaneous coronary intervention (PCI) in patients with diabetes (DM) and multivessel disease (MVD). However, differences in survival are equivocal and outcomes according to sex remain unknown.

METHODS AND RESULTS: Patients with DM and MVD undergoing either PCI (with drug-eluting stents) or CABG within 90-days of cardiac catheterization between 01/05/2009-03/29/2019 in Alberta, Canada were included. Patients were required to be free of prior revascularization or other cardiac interventions. The outcomes of interest were all-cause death and the composite of all-cause death or myocardia infraction (MI) at 5-years. Rates and survival probabilities to 5-years were estimated by type of revascularization and sex. Cox proportional hazards model was used to examine sex difference outcomes stratified by revascularization.Among 4803 patients, 2941 underwent PCI (805 females [27%]; 2136 males [73%]) and 1862 underwent CABG (391 females [21%] and 1471 males [79%]). Regardless of type of revascularization females were older, had higher body mass index and comorbidity burden, were less likely to smoke and more likely to present with non ST-elevation MI. Females versus males had higher rates of death (PCI: F 4.2, M 3.0 per 100 person-year, p=0.0013; CABG: F 4.8, M: 3.7 per 100 person-year, p=0.0035) and death or MI (PCI: F 6.2, M 4.7 per 100 person-year, p=0.0026; CABG: F 5.9, M: 4.7 per 100 person-year, p=0.0044) at 5 years. However, regardless of revascularization, there was no difference in survival by sex after adjusting other covariates (PCI: Adjusted HR 1.15, 95% CI 0.90-1.46; CABG: Adjusted HR 1.26, 95% CI 0.93-1.70). Similar findings were observed for death or MI (PCI: Adjusted HR 1.14, 95% CI 0.94-1.40; CABG: Adjusted HR 1.23, 95% CI 0.94-1.61).

Conclusion: In a large real-world analysis of diabetics with MVD selected for revascularization, female sex was associated with a higher risk of death and death/MI at 5 years compared to male sex. However, the higher risk associated with both revascularization strategies among women compared to men was explained by differences in demographic and clinical characteristics. Our results could be considered when contemplating a revascularization strategy based on sex and clinical outcome.