A sex paradox in clinical outcomes following complex percutaneous coronary intervention

Nicolas, Johny; Claessen, Bimmer E.; Cao, Davide; Chiarito, Mauro; Sartori, Samantha; Qiu, Hanbo; Goel, Ridhima; Nardin, Matteo; Roumeliotis, Anastasios; Vogel, Birgit; Turfah, Ali; Chandiramani, Rishi; Baber, Usman; Barman, Nitin; Sweeny, Joseph; Ramanathan, Krishnan; Kini, Annapoorna; Sharma, Samin K.; Dangas, George; Mehran, Roxana

doi:10.1016/j.ijcard.2020.11.067

Cited by 15 publications

(22 citation statements)

References 31 publications

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“…• Risk factors of periprocedural complications in general for RA PCI were: again female sex along with bifurcation PCI, radial access, low molecular weight heparin, cardiac arrest at baseline, multi-vessel disease, etc. In line with these observations are data from a recent registry [11] showing that women had a higher rate of myocardial infarction at one year following complex PCI (even after adjusting for potential confounders), even though they present with less challenging lesions than men. Moreover, Ford et al [12] showed that women undergoing RA PCI are at greater risk of bleeding complications and coronary perforations leading to cardiac tamponade.…”

supporting

confidence: 55%

Understanding the role of female sex in patients undergoing pci with rotational atherectomy

Giannini¹,

Tzanis²

2021

Kardiol Pol

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supporting

confidence: 55%

Understanding the role of female sex in patients undergoing pci with rotational atherectomy

Giannini¹,

Tzanis²

2021

Kardiol Pol

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“…Our results show that females have a higher risk of in-hospital bleeding compared with males which is similar to results of prior studies. 25,38,39 Four of 14 studies included in our meta-analysis reported access site and based on results, females had higher use of femoral access when compared with males (69% vs. 62%) which might be a plausible explanation for the higher bleeding risk in women. 18,19,25,27 and Society for Cardiovascular Angiography and Interventions PCI guidelines.…”

Section: Discussionmentioning

confidence: 96%

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

Latif

Ahsan

Lateef

et al. 2021

Cathet Cardio Intervent

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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 = À0.17; 95% CI: À0.25 to À0.10). Females had statistically higher success rates of CTO PCI (RR = 1.03; 95% CI: 1.01 to1.05), required less contrast volume (MD = À18.64: 95% CI: À30.89 to À6.39) and fluoroscopy time (MD = À9.12; 95% CI: À16.90 to À1.34) 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.

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“…A recent study that looked at sex-related outcomes in complex-PCI versus noncomplex-PCI in a large-volume single tertiary-care center concluded that a sex-paradox exists. 13 Females tend to have less complex coronary artery disease yet paradoxically suffer from higher rates of adverse outcomes following complex PCI. However, this single-center study's findings may not apply to patients undergoing complex PCI in other centers and cannot inform national practice.…”

Section: Introductionmentioning

confidence: 99%

“…However, studies looking at whether such sex disparities are observed in CHiP are limited. A recent study that looked at sex‐related outcomes in complex‐PCI versus noncomplex‐PCI in a large‐volume single tertiary‐care center concluded that a sex‐paradox exists 13 . Females tend to have less complex coronary artery disease yet paradoxically suffer from higher rates of adverse outcomes following complex PCI.…”

Section: Introductionmentioning

confidence: 99%

Sex differences in high‐risk but indicated coronary interventions (CHiP): National report from British Cardiovascular Intervention Society Registry

Shamkhani

Kinnaird

Ludman

et al. 2022

Cathet Cardio Intervent

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Objective: To assess sex-based differences in clinical outcomes following complex and high-risk but indicated percutaneous coronary intervention (CHiP).Background: CHiP is increasingly common in contemporary percutaneous coronary intervention (PCI) practice. Data on sex differences in the type of CHiP procedures undertaken or their associated clinical outcomes are limited.Methods: Patients with stable coronary artery disease who underwent CHiP between January 1, 2006, and December 31, 2017, were included. All procedures were stratified by sex. Multivariate logistic regression analyses were performed to investigate the sex-specific adjusted odds ratios (aOR) of in-hospital outcomes.Results: Out of 424,290 PCI procedures, 141,610 (33.37%) were CHiP procedures.Overall, 32,129 (23%) of CHiP were undertaken in females. Females were older than males (median: 74.8 vs. 69.1 years). Males had a higher prevalence of previous myocardial infarction (MI) (44.6% vs. 35.6%) and previous PCI (40% vs. 32.5%). The most common variable observed in female patients undergoing CHiP was age >80 (35.4%), followed by prior coronary artery bypass graft (CABG) (24.3%) and severe coronary calcification (22.6%). In contrast, the most common variable in male patients was prior CABG (36%), followed by chronic thrombus occlusion (CTO) PCI (34.4%) and severe coronary calcification (22%). Females had higher odds (aOR) for mortality (aOR: 1.

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A sex paradox in clinical outcomes following complex percutaneous coronary intervention

Cited by 15 publications

References 31 publications

Understanding the role of female sex in patients undergoing pci with rotational atherectomy

Understanding the role of female sex in patients undergoing pci with rotational atherectomy

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

Sex differences in high‐risk but indicated coronary interventions (CHiP): National report from British Cardiovascular Intervention Society Registry

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