Ten-year follow-up survival of the medicine, angioplasty, or surgery study (MASS II): randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease in women

Abstract

Purpose: Coronary artery disease (CAD) is the leading cause of death in women. The proposed treatments, percutaneous coronary intervention (PCI), medical treatment (MT) or coronary artery bypass graft (CABG), are similar to those madefor men. However, in women with multivessel stable CAD and normal left ventricular (LV) function, the best treatment is unknown. Methods: Prospective study with 10 years of follow-up randomized 188 womenwith chronic stable CAD to MT (N = 63; 33%), PCI (N = 69; 37%) or CABG (N = 56; 30%). CAD was defined by the presence of angina pectoris CCS class II and III, positive stress test, LV ejection fraction > 40% and ≥ 2 coronary lesions >70%. The primary end points were the incidence of total mortality, Q-wave MI, or refractory angina that required revascularization. All data were analyzed according to the intention-to-treat principle. Results: Patients treated with PCI and MT had more primary events than CABG and, respectively, of 34%, 44% and 22% (p=0.003) (Figure). The 10-year survival rates were 72% with CABG, 72% with PCI, and 56% with MT (p=0.156). Relative to the composite end point, Cox regression analysis showed a higher incidence of primary events in MT than in CABG [HR=2.38 (95%CI: 1.40 to 4.05); p=0.001], lower incidence in PCI than in MT [HR=0.60 (95%CI: 0.38 to 0.95); p=0.031] but no differences between CABG and PCI [HR=1.42 (95%CI: 0.83 to 2.45); p=0.203]. To death, a protective effect of PCI compared to MT [HR=0.44 (95%CI: 0.21 to 0.90); p=0.025] was observed but not between PCI and CABG or MT and CABG. Conclusion: Women with multivessel CAD and normal LV function, CABG and PCI were associated with fewer primary events and PCI with lower mortality.