Percutaneous Coronary Intervention or Optimal Medical Therapy for Woven Coronary Anomaly (The Multicenter EVOLUTE-WOVEN Study).

Woven coronary artery anomaly (WCAA) is a rare congenital anomaly in which a coronary artery is divided into thin channels. This study aimed to assess the clinical outcomes of the percutaneous coronary intervention (PCI) and guideline-directed medical therapy (GDMT) in patients with WCAA under mid-term follow-up. From 2011 to 2025, patients who underwent PCI or received GDMT for WCAA were retrospectively collected. The primary outcome measurement was defined as a major adverse cardiac event (MACE) and was the composite of cardiac death, target-vessel myocardial infarction (MI), target vessel revascularization, or rehospitalization for angina pectoris. The secondary endpoint was defined as the combination of death or target-vessel MI during follow-up. Sixty-one consecutive WCAA patients [male:52 (85%), mean age:56.27 ± 9.89 years] were included in this multicenter (n = 12) study. The study cohort was divided into 2 groups: PCI (n = 30) and GDMT (n = 31). The most commonly used guidewires for successful wiring were Fielder XT-R and Gladius MG. The MACE (19% vs 3.3%, p = 0.104), death or MI (13% vs 3.3%, p = 0.354), and rehospitalization for angina (19% vs 3.3%, p = 0.104) rates were numerically higher in the GDMT group than in the PCI group. Inverse probability weighted-Cox regression analysis showed that the MACE (unadjusted HR 0.091, p = 0.028) was significantly different, while death or MI (unadjusted HR 0.160, p = 0.101) did not differ between the 2 groups. In conclusion, current data suggest that PCI may be associated with a lower risk of MACE, mainly driven by rehospitalization for angina pectoris, and comparable death or MI to GDMT; however, a strong inference cannot be made due to the retrospective observational design.