Gender-based acute outcome in percutaneous coronary intervention of chronic total coronary occlusion

Sex Differences in Clinical Profile and Outcome After Percutaneous Coronary Intervention for Chronic Total Occlusion

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.

Gender-based differences in primary percutaneous coronary intervention in patients with myocardial infarction from a developing country: A retrospective cohort study

Introduction

Limited data exists about gender's impact on differences in risk factors and outcomes in our setting. Therefore, we sought to ascertain sex-related differences in patients with AMI in our setting.

Material and methods

This retrospective study analyzed data from 247 myocardial infarction patients hospitalized in a tertiary care hospital, between March and October 2020. After hospital admission, all patients underwent ECG, myocardial enzymes, troponin and other biochemical tests followed by primary PCI.

Results

Patients were divided in two groups male (n = 153, mean age 55.2 ± 11.0 years) and female (n = 94, mean age 58.4 ± 12.7 years). The prevalence of smoking was higher in males than females (22.8% vs. 3.1%, p < 0.01) and so was history of three-vessel disease (3VD; 18.9% vs. 7.4%, p = 0.013). History of myocardial infarction was lower in females than males (13.8% vs. 24.8%, p = 0.03) however the age did not vary significantly between the two groups (p = 0.21). Serum creatinine (sCr) levels (1.0 ± 0.77 μmol/L vs. 1.2 ± 0.73 μmol/L, p = 0.28) and body mass index (28.4 ± 5.3 vs 27.4 ± 4.8, p = 0.45) were lower in females as compared to males, however not statistically significant. The incidence of major adverse events, severe arrhythmia and in-hospital outcomes showed no significant difference (p > 0.05) between the two groups. Post-op TIMI score and average length of hospital stay were not statistically different either (3.29 ± 2.9 vs. 2.6 ± 1.7, p = 0.726).

Conclusion

Our study shows that females have a comparable age of onset of major cardiovascular events as that of males. Post-PCI clinical outcomes and in-hospital stay had no significant differences between the two groups.

What is already known on this topic:•

Limited data exists about gender's impact on differences in risk factors and outcomes STEMI in developing countries like Pakistan.

•

Previous analyses on gender disparities have revealed higher mortality in females compared to males when hospitalized for STEMI.

What this study adds:

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The incidence of major adverse events during in-hospital stay showed no significant difference among gender.

•

The prevalence of smoking and 3VD in males was higher than in females. Despite of differences in co-morbidities between the groups, clinical outcomes remained consistent.

Procedural Outcomes in Patients Treated with Percutaneous Coronary Interventions within Chronic Total Occlusions Stratified by Gender

It has been demonstrated that gender differences are related to different procedural and long-term clinical outcomes among a general patient population treated using percutaneous coronary interventions (PCI). The objective of our analysis was to conduct assessment regarding the relationship between gender and procedural outcomes in patients treated for PCI regarding chronic total occlusions (CTO), based on a large, real-life registry. Data used to conduct the following analysis was derived from the national registry of percutaneous coronary interventions (ORPKI), upheld in co-operation with the Association of Cardiovascular Interventions (AISN) of the Polish Cardiac Society. The study involved data procured from the registry within the period from January 2014 to December 2020. All subsequent CTO procedures recorded in the registry during that period were included in the analysis. We assessed the correlation between gender and the overall rate of periprocedural complications, procedure-related mortality, and success evaluated as TIMI flow grade 3 after the procedure by univariate and multivariable modeling. At the time of conducting our investigation, there were 162 existing and active CathLabs, at which 747,033 PCI procedures were carried out during the observational period. Of those, 14,903 (1.99%) were CTO-PCI procedures, and 3726 were women (25%). The percentage share between genders did not experience any significant changes during the consecutive years observed in the current analysis. Overall periprocedural complication rate was greater among women than men (3.45% vs. 2.31%, p = 0.02). A comparable relationship was noted for procedural mortality (0.7% vs. 0.2%, p = 0.006), while procedural success occurred more often in the case of women (69.3% vs. 65.2%, p < 0.001). Women were found to be more frequently affected by periprocedural complications (OR = 1.553; 95%CI: 1.212−1.99, p < 0.001) as well as procedural success (OR = 1.294; 95%CI: 1.151−1.454, p < 0.001), evaluated using multivariable models. Based on the current analysis performed on all-comer patients treated using PCI in CTO, women are affected by more frequent procedural complication occurrence as well as greater procedural success compared to men.

Impact of sex on outcomes of percutaneous coronary intervention for chronic total occlusion: A meta-analysis

BACKGROUND

Women are underrepresented in chronic total occlusion (CTO) trials and little is known about sex differences in the outcomes of CTO percutaneous coronary intervention (PCI). This meta-analysis aims to compare the outcomes of CTO PCI in males and females.

METHODS

A comprehensive search of PubMed, EMBASE, Cochrane, Web of Science, and Google Scholar was performed for studies comparing outcomes of CTO PCI in females versus males from inception to January 26, 2021. The current statistical analysis was performed using STATA version 15.1 software (Stata Corporation, TX); P < 0.05 indicated statistical significance.

RESULTS

Fourteen observational studies were included in the analysis with 75% males and 25% females. The mean age was 64.47 ± 10.5 years and 68.98 ± 9.5 years for males and females, respectively. The median follow-up duration was 2.4 years. Males had a higher Japanese-CTO (J-CTO) score compared with females (MD = -0.17; 95% CI: -0.25 to -0.10). Females had statistically higher success rates of CTO PCI (RR = 1.03; 95% CI: 1.01 to1.05), required less contrast volume (MD = -18.64: 95% CI: -30.89 to -6.39) and fluoroscopy time (MD = -9.12; 95% CI: -16.90 to -1.34) compared with males. There was no statistical difference in in-hospital (RR = 1.50; 95% CI: 0.73 to 3.09) or longer term (≥6 months) all-cause mortality (RR = 1.10; 95% CI: 0.86 to 1.42) between the two groups.

CONCLUSIONS

CTO PCI is feasible and safe in female patients with comparable outcomes in female versus male patients.

Sex differences in procedural and clinical outcomes following rotational atherectomy

AIM

Evaluate sex differences in procedural net adverse clinical events and long-term outcomes following rotational atherectomy (RA).

METHODS AND RESULTS

From August 2010 to 2016, 765 consecutive patients undergoing RA PCI were followed up for a median of 4.7 years. 285 (37%) of subjects were female. Women were older (mean 76 years vs. 72 years; p < .001) and had more urgent procedures (64.6 vs. 47.3%; p < .001). Females received fewer radial procedures (75.1 vs. 85.1%; p < .001) and less intravascular imaging guidance (16.8 vs. 25.0%; p = .008). After propensity score adjustment, the primary endpoint of net adverse cardiac events (net adverse clinical events: all-cause death, myocardial infarction, stroke, target vessel revascularization plus any procedural complication) occurred more often in female patients (15.1 vs. 9.0%; adjusted OR 1.81 95% CI 1.04-3.13; p = .037). This was driven by an increased risk of procedural complications rather than procedural major adverse cardiac events (MACE). Specifically, women were more likely to experience coronary dissection (4.6 vs. 1.3%; p = .008), cardiac tamponade (2.1 vs. 0.4%; p = .046) and significant bleeding (BARC ≥2: 5.3 vs. 2.3). Despite this, overall MACE-free survival was similar between males and females (adjusted HR 1.03; 95% CI 0.80-1.34; p = .81). Procedural complications during RA were associated with almost double the incidence of MACE at long-term follow-up (HR 1.92; 95% CI 1.34-2.77; p < .001).

CONCLUSION

Women may be at greater risk of procedural complications following rotational atherectomy. These include periprocedural bleeding episodes and coronary perforation leading to cardiac tamponade. Despite this, the adjusted overall long-term survival free of major adverse cardiac events was similar between males and females.

Is sex associated with adverse outcomes after percutaneous coronary intervention for CTO?

BACKGROUND

Conflicting results have been reported regarding sex differences in percutaneous coronary intervention (PCI), but their potential influence on clinical outcomes after chronic total coronary occlusion (CTO) PCI remains unknown. We aimed to identify sex-related differences in long-term clinical outcomes after CTO PCI.

METHODS AND RESULTS

All consecutive patients undergoing CTO PCI between 2004 and 2012 were included in a prospective registry. Baseline, procedural characteristics and clinical outcomes were compared according to sex. Out of 1343 patients, 194 were female (14.4%). Women were older (68.5 ± 9.9 vs 62.3 ± 10.8 years, p < 0.001), more frequently diabetic (33.5% vs 26.4%, p = 0.026) and hypertensive (70.1% vs 57.4%, p < 0,001), whereas males were more frequently smokers (28.5% vs 15.5%, p < 0.001). J-CTO score was similar between both sexes (1.59 ± 0.91 vs 1.51 ± 0.88). The procedural success rate was also similar in men and women (74.0% vs 77.3%, respectively). At 8 years' follow-up, successful CTO PCI was associated with reduced mortality in women (14.8% vs 36.2%, p = 0.003) and men (18.5% vs 29.1%, p < 0.001). In successful CTO PCI cases, no sex-related differences were observed in terms of major adverse cardiac events.

CONCLUSIONS

Our study suggests an equal benefit of CTO interventions with a marked reduction in mortality after successful CTO PCI in women and men alike.

Temporal changes in outcomes of women and men undergoing percutaneous coronary intervention for chronic total occlusion: 2005-2013

OBJECTIVE

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has undergone impressive progress during the last decade, both in strategies and equipment. It is unknown whether technical refinement has translated into improved outcomes in women undergoing CTO-PCI.

METHOD AND RESULTS

A total of 2002 consecutive patients (17% females, mean age 65.2 ± 10.7 years) undergoing PCI of at least one CTO lesion at our center between 01/2005 and 12/2013 were evaluated. The incidence of adverse events was compared between two time series (2005-2009 and 2010-2013). A significant increase in adverse lesion characteristics over time was noted in both, women and men (p < 0.001), while technical success rates significantly increased in men but not in women (p_trend < 0.001 in men and p_trend=0.9 in women). The incidence of procedural complications was significantly higher in women as compared to men and increased over the study period in women (p < 0.05) but not in men. Accordingly, multivariate logistic regression analysis identified female sex as a strong predictor of PCI-related complications in recent years, while this was not the case in earlier years (adjusted HR 2.03, 95% CI 0.62-6.6, p = 0.2 and adjusted HR 4.7, 95% CI 1.8-12.3, p = 0.002, respectively, p < 0.001 for log LH ratio). In addition, major adverse cardiovascular events (MACE) after a 3-year follow-up significantly declined in men (log rank = 0.046), while no changes were observed in women.

CONCLUSION

While higher success rates and a reduced rate of MACE have been achieved in men, the incidence of procedural complications in women undergoing CTO-PCI has increased over time.