• Pierre Meynet, Riccardo Improta, Maria Luisa Carbone, Martina Pecoraro, Ilaria Pagliassotto, Gianluca Di Pietro, Michelle Demetres, Francesco Bruno, Gaia Comitini, Attilio Leone, Eleonora Martinengo, Stefano Siliano, Fabrizio D'Ascenzo, Alaide Chieffo, Gaetano Maria De Ferrari, Mario Gaudino, Massimo Mancone, Antonino Di Franco, and Ovidio De Filippo.
• Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy.
• Eur. J. Clin. Invest. 2024 Nov 14: e14348e14348.

BackgroundThe role of sex in choosing between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) disease has gained interest.MethodsRandomized controlled trials and adjusted observational studies comparing PCI versus CABG in ULMCA patients with outcomes by sex were included. The primary endpoint was major adverse cardiovascular events (MACE), with secondary endpoints being all-cause mortality and repeated revascularization.ResultsTen studies (3 randomized, 7 observational) involving 22,141 ULMCA disease patients (13,411 PCI, 8730 CABG) with a median 5-year follow-up were included. Among males, PCI was associated with a higher risk of MACE (HR 1.18, 95% CI 1.01-1.38), while no significant difference was seen in females. However, moderator analysis showed no significant interaction between sex and revascularization strategy for MACE (p for interaction .422). No differences in all-cause mortality were observed between PCI and CABG for either sex. Repeated revascularization risk was significantly higher with PCI for both sexes (HR 3.51, 95% CI 2.21-5.59 in males and HR 4.20, 95% CI 2.57-6.87 in females).ConclusionsIn males with ULMCA disease, CABG was associated with a lower risk of MACE compared to PCI, while no significant differences were seen in females. The lack of a significant interaction between sex and revascularization strategy suggests that these findings may not reflect true sex-based effect modification. PCI was linked to a higher risk of repeated revascularization in both sexes compared to CABG.Trial RegistrationThe protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42024537726).© 2024 The Author(s). European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.

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