TOPLINE:

In women with chronic severe coronary artery disease (CAD), revascularization with coronary artery bypass grafting (CABG) was associated with lower occurrences of major adverse cardiovascular and cerebrovascular events (MACCEs) and all-cause mortality over 5 years than with percutaneous coronary intervention (PCI), despite higher in-hospital mortality rates.

METHODOLOGY:

• Researchers used datasets from Canada and conducted a retrospective cohort study to compare the long-term outcomes of two revascularization procedures in women with chronic severe CAD.
• Severe CAD was defined as left main disease, three-vessel disease, or two-vessel disease involving the proximal left anterior descending artery.
• Eligible women were older than 18 years and younger than 80 years who underwent CABG or PCI for the first time between April 2012 and December 2021. All women had at least 6 months of follow-up.
• After propensity score matching, 2033 women who underwent PCI were paired with 2033 who underwent CABG (mean age, 66.6 years). The median follow-up duration was 5.1 years.
• The primary outcome was MACCEs, defined as a composite of all-cause mortality, myocardial infarction, stroke, and repeat revascularization. Additional outcomes included cardiovascular readmission and in-hospital outcomes.

TAKEAWAY:

• Women who underwent PCI experienced MACCEs more often than those who underwent CABG (hazard ratio [HR], 1.81; P < .001; 5-year cumulative incidence, 35.8% vs 21.5%).
• PCI was associated with higher occurrences of all-cause mortality (HR, 1.34), myocardial infarction (HR, 2.23), repeat revascularization (HR, 2.61), and cardiovascular readmission (HR, 1.40) than CABG (P < .001 for all).
• Stroke was less common after PCI than after CABG (HR, 0.76; P < .001).
• In-hospital mortality was nearly half as likely with PCI as with CABG (odds ratio, 0.51; P = .04).

IN PRACTICE:

“Our findings provide evidence to suggest women with chronic severe CAD may derive greater long-term benefit from CABG compared with PCI and support consideration of CABG as the preferred revascularization strategy in appropriately selected women,” the researchers of the study wrote.

SOURCE:

The study was led by Kevin R. An, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. It was published online on November 25, 2025, in the European Heart Journal.

LIMITATIONS:

Despite propensity score matching, unmeasured covariates may have remained unbalanced. Left ventricular ejection fraction and disease complexity of CAD were unaccounted for. Events were not adjudicated because the data were retrieved from administrative datasets.

DISCLOSURES:

The study received support from the Institute for Clinical Evaluative Sciences, which is funded by Ontario’s Ministry of Health and Ministry of Long-Term Care. One author reported receiving support from the Canadian Cardiovascular Society-Bayer Cardiovascular Research Award and another from Weill Cornell Medicine Institutional Research Funds for the study. Two authors reported receiving institutional research funding from two institutes for clinical trials unrelated to the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.