Sex differences in clinical profile and outcome after percutaneous coronary intervention for chronic total occlusion.

Mamas; Rashid

Abstract

BACKGROUND: There are limited data around sex differences in the risk profile, treatments and outcomes of percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) lesions in contemporary interventional practice. We investigated the impact of sex on clinical and procedural characteristics, complications and clinical outcomes in a national cohort.

METHODS & RESULTS: We created a longitudinal cohort (2006-2018, n = 30,605) of patients with stable angina who underwent CTO PCI in the British Cardiovascular Intervention Society (BCIS) database. Clinical, demographic, procedural and outcome data were analysed in two groups stratified by sex: male (n = 24,651), female (n = 5954). Female patients were older (68 vs 64 years, P < 0.001), had higher prevalence of diabetes mellitus (DM), hypertension (HTN) and prior stroke. Utilization of intravascular ultrasound (IVUS), drug eluting stents (DES), radial or dual access and enabling strategies during CTO PCI were higher in male compared to female patients. Following multivariable analysis, there was no significant difference in in-patient mortality (adjusted odds ratio (OR):1.40, 95 % CI: 0.75-2.61, P = 0.29) and major cardiovascular and cerebrovascular events (MACCE) (adjusted OR: 1.01, 95 % CI: 0.78-1.29, P = 0.96). The crude and adjusted rates of procedural complications (adjusted OR: 1.37, 95 % CI: 1.23-1.52, P < 0.001), coronary artery perforation (adjusted OR: 1.60, 95 % CI: 1.26-2.04, P < 0.001) and major bleeding (adjusted OR: 2.06, 95 % CI: 1.62-2.61, P < 0.001) were higher in women compared with men.

CONCLUSION: Female patients treated by CTO PCI were older, underwent lesser complex procedures, but had higher adjusted risk of procedural complications with a similar adjusted risk of mortality and MACCE compared with male patients.

Citation

Mamas, & Rashid. (2022). Sex differences in clinical profile and outcome after percutaneous coronary intervention for chronic total occlusion. Cardiovascular Revascularization Medicine, 49, 34-41. https://doi.org/10.1016/j.carrev.2022.12.005

• Acceptance Date: Dec 13, 2022
• Publication Date: Dec 16, 2022
• Journal: Cardiovascular Revascularization Medicine
• Print ISSN: 1553-8389
• Electronic ISSN: 1878-0938
• Publisher: Elsevier
• Volume: 49
• Pages: 34-41
• DOI: https://doi.org/10.1016/j.carrev.2022.12.005
• Keywords: Percutaneous coronary intervention; Sex; Chronic total occlusion; Mortality
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1553838922009265?via%3Dihub
• Additional Information: © 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)