Comparison of Characteristics and Complications in Men Versus Women Undergoing Chronic Total Occlusion Percutaneous Intervention

Sharma, Vishal; Wilson, William; Smith, William; McEntegart, Margaret; Oldroyd, Keith G.; Sidik, Novalia; Bagnall, Alan; Egred, Mohaned; Irving, John; Strange, Julian; Johnson, Tom; Walsh, Simon; Hanratty, Colm G.; Spratt, James C.

doi:10.1016/j.amjcard.2016.11.004

Cited by 37 publications

(44 citation statements)

References 32 publications

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“…Lesion length was shorter in women. There has been discordance in prior studies about procedural success and complication risk of CTO PCI by sex . In this study, procedural success and MACCE rates were similar in both sexes.…”

Section: Discussioncontrasting

confidence: 55%

“…There has been discordance in prior studies about procedural success and complication risk of CTO PCI by sex. 4,8,9 In this study, procedural success and MACCE rates were similar in both sexes. Smaller coronary artery diameters 22 and more tortuous collaterals have been hypothesized as reasons for less success with retrograde CTO PCI in women but in this cohort, sex had no impact on the approach (antegrade vs retrograde) or final successful strategy (wire escalation vs dissection re-entry).…”

Section: Discussionsupporting

confidence: 53%

“…Women have a similar prevalence of CTO's as men . Time to presentation for invasive treatment is usually later than men and presentation symptoms in women with CTO's are often different . When compared with men, women have smaller coronary vessels and this has been considered to be an important basis for sex differences in outcomes despite lesser plaque volume in women.…”

Section: Introductionmentioning

confidence: 99%

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A sex stratified outcome analysis from the OPEN‐CTO registry

Pershad

Gulati

Karmpaliotis

et al. 2018

Cathet Cardio Intervent

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Introduction: Women have been under-represented in trials. Due to the dearth of information about CTO-PCI in women and discordance of previous results, sex differences in outcomes in the OPEN-CTO Trial were investigated.Methods: OPEN-CTO is an investigator-initiated, multicenter, prospective observational registry of consecutive CTO patients undergoing PCI at 12 U.S. centers. The one-year outcomes of this trial stratified by sex were examined. Optimal propensity matching was performed to compare outcomes between sexes. Multivariate conditional logistic regression modeling for predictors of procedural success was performed.Results: Women represented 19.6% of the cohort (196/1,000 patients). Women were more likely to report dyspnea as their predominant symptom. Women reported statistically worse physical limitation and poorer quality of life as compared to men. J-CTO scores were similar in males and females. Technical, procedural success and MACE rates were similar in both sexes.Contrast and radiation doses were however significantly lower in women. The SAQ-summary score, RDS, EQ-5D VAS, PHQ-8 scores were all improved to the same degree at 1 year in women as compared to men. Predictors of procedural success revealed that younger age, lower J-CTO score and absence of prior CABG were predictors of procedural success. Sex did not predict procedural success or 1-year MACE in this regression model.Conclusion: This real-world registry revealed that women derive the same benefit from CTO-PCI as men without additional complications and with favorable health status outcomes at 1 year. Consideration of revascularization by PCI in symptomatic women should be considered as part of the treatment when appropriate. K E Y W O R D S CTO-PCI, females, health status 1 | INTRODUCTION Women have been under-represented in cardiovascular interventional trials. 1,2 This under-representation is evident in the chronic total occlusion (CTO) literature. Due to the low number of women enrolled in clinical trials, evaluating outcomes after CTO-PCI in women has been difficult. Women have a similar prevalence of CTO's as men. 3 Time to presentation for invasive treatment is usually later than men and presentation symptoms in women with CTO's are often different. 4 When compared with men, women have smaller coronary vessels and this has been considered to be an important basis for sex differences in outcomes despite lesser plaque volume in women. Nonetheless, when controlled for body surface area (BSA), women have similar vessel sizes as men. 5 Women also have increased bleeding risks and vascular complication after PCI 6,7 and may impact outcomes in CTO. CTO's have different angiographic characteristics in women. 8 Despite favorable angiographic characteristics, the impact of sex on outcomes of CTO-PCI in women has been mixed. 9 Due to the relative Women derived the same benefit from CTO-PCI as men in this multicenter, core lab adjudicated prospective registry. The procedural success and complications in females were the same as in men. At 1 year...

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A sex stratified outcome analysis from the OPEN‐CTO registry

Pershad

Gulati

Karmpaliotis

et al. 2018

Cathet Cardio Intervent

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“…Indeed, there is significant overlap between our cohort with complex co‐morbidities and calcific disease and the chronic total occlusion (CTO) PCI population. A large contemporary CTO registry similarly showed that women suffer more periprocedural complications including coronary perforation and bleeding (women 10.0 vs. men 4.5%, p = .0012) …”

Section: Discussionmentioning

confidence: 97%

Sex differences in procedural and clinical outcomes following rotational atherectomy

Ford

Khan

Docherty

et al. 2019

Cathet Cardio Intervent

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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).

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“…Of these, 93.6% were older than 50 years. Analyzes conducted in the UK with 1,271 patients found that 79.5% were males and 20.5% females, in view of this, the comparative study shows that 48.1% of the female population had age group over 70 years, whereas in men this percentage was only 28.6% (12) .…”

Section: Discussionmentioning

confidence: 74%

Clinical-epidemiological aspects of patients submitted to Percutaneous Coronary Intervention in a university hospital

et al. 2018

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Objective: To outline the clinical-epidemiological profile of patients submitted to Percutaneous Coronary Intervention in a Reference Hospital in Urgent Cardiology Clinic of the state of Rio Grande do Norte. Method: This is a descriptive, exploratory, prospective study with a quantitative approach developed in a Brazilian University Hospital with patients submitted to Percutaneous Coronary Intervention. Data collection occurred between April and October 2017. Results: The sample consisted of 222 patients, of whom 58.10% underwent Elective Percutaneous Coronary Intervention and 41.89% were primary, 65.3% males, with a mean age of 62.7. In comorbidities “Hypertension”, “Acute Myocardial Infarction”, “Current Smoking” and “Physical Inactivity” were highlighted. Conclusion: In the elective patients, there was a high prevalence of risk factors and in patients with urgent cases, high time of total ischemia. It is necessary to create strategies to structure the care line, to improve the effectiveness of treatment and to minimize adverse outcomes.

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Comparison of Characteristics and Complications in Men Versus Women Undergoing Chronic Total Occlusion Percutaneous Intervention

Cited by 37 publications

References 32 publications

A sex stratified outcome analysis from the OPEN‐CTO registry

A sex stratified outcome analysis from the OPEN‐CTO registry

Sex differences in procedural and clinical outcomes following rotational atherectomy

Clinical-epidemiological aspects of patients submitted to Percutaneous Coronary Intervention in a university hospital

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