Effect of Sex on Outcomes of Coronary Rotational Atherectomy Percutaneous Coronary Intervention (From the European Multicenter Euro4C Registry)

Bouisset, Frédéric; Ribichini, Flavio; Bataille, Vincent; Reczuch, Krzysztof; Dobrzycki, Sławomir; Meyer‐Geßner, Markus; Bressollette, Erwan; Zajdel, Wojciech; Faurie, Benjamin; Mezilis, Nikolaos; Palazuelos, Jorge; Spedicato, Leonardo; Valdés, Mariano; Vaquerizo, Beatriz; Ferenc, Mirosław; Cayla, Guillaume; Barbato, Emanuele; Carrié, Didier; Investigators, Euro C Registry

doi:10.1016/j.amjcard.2020.12.040

Cited by 6 publications

(11 citation statements)

References 21 publications

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“…Of note, the Euro4C registry indicated that women had worse clinical outcomes following RA during hospitalization and at 1-year follow-up. However, the procedural complications did not significantly differ between genders, and the reasons for poor clinical outcomes in women following RA remained unknown (27). In our study, female gender was a predictor for in-hospital CV MACE but not for 1-year CV MACE.…”

Section: Multivariable Logistic Regression Analysis For In-hospital A...contrasting

confidence: 48%

The Procedural and Clinical Outcomes of Rotational Atherectomy in Patients Presenting With Acute Myocardial Infarction

Chen

Lai

et al. 2022

Front. Cardiovasc. Med.

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BackgroundRotational atherectomy (RA) is an indispensable tool used for calcified lesion preparation in percutaneous coronary intervention (PCI). However, use of RA in the setting of acute myocardial infarction (AMI) is challenged with limited clinical data.ObjectivesThis study aims to retrospectively investigate the procedural results, periprocedural complications, and clinical outcomes of RA in patients with AMI.MethodsAll possible consecutive patients who received RA in AMI from January 2009 to March 2018 in a single tertiary center were analyzed retrospectively. Patients without AMI during the study period were also enrolled for comparison.ResultsA total of 121 patients with AMI (76.0 ± 10.8 years, 63.6% males) and 290 patients without AMI were recruited. Among the AMI group, 81% of patients had non-ST-elevation myocardial infarction (NSTEMI) and 14% presented with cardiogenic shock. RA could be completed in 98.8% of patients in the AMI group and 98.3% in the non-AMI group (p = 1.00). The periprocedural complication rates were comparable between the AMI and non-AMI groups. The risks of in-hospital, 30-day, 90-day, and 1-year cardiovascular major adverse cardiac events (CV MACE) were significantly higher in the AMI group compared with the non-AMI group (in-hospital 13.2 vs. 2.8%, p < 0.001; 30-day 14.2 vs. 4.5%, p < 0.001; 90-day 20.8 vs. 6.9%, p < 0.001; 1-year 30.8 vs. 19.1%, p = 0.01). AMI at initial presentation and cardiogenic shock were predictors for both in-hospital CV MACE and 1-year CV MACE in multivariable binary logistic regression analysis. Other predictors for 1-year CV MACE included serum creatinine level and triple vessel disease.ConclusionRA in patients with AMI is feasible with a high procedural completion rate and acceptable periprocedural complications. Given unstable hemodynamics and complex coronary anatomy, the in-hospital and 1-year MACE rates remained higher in patients with AMI compared with patients without AMI.

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Section: Multivariable Logistic Regression Analysis For In-hospital A...contrasting

confidence: 48%

The Procedural and Clinical Outcomes of Rotational Atherectomy in Patients Presenting With Acute Myocardial Infarction

Chen

Lai

et al. 2022

Front. Cardiovasc. Med.

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“…1,8 It has been previously suggested that women, due to sex-specific peculiarities in arterial access, bleeding risk and coronary pathophysiology, may be particularly susceptible to complications (especially coronary artery perforation) following RA compared with men. [9][10][11] In the context of this setting, the aim of this study, a sub-analysis of the PREPARE-CALC trial, was to investigate the sex-specific differences in calcified coronaries in general and according to different lesion preparation strategies.…”

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confidence: 99%

“…[ 1 , 8 ] It has been previously suggested that women, due to sex-specific peculiarities in arterial access, bleeding risk and coronary pathophysiology, may be particularly susceptible to complications (especially coronary artery perforation) following RA compared with men. [ 9 – 11 ]…”

mentioning

confidence: 99%

Sex-specific Inequalities in the Treatment of Severely Calcified Coronary Lesions: A Sub-analysis of the PREPARE-CALC Trial

Fitzgerald¹,

Giménez

Allali

et al. 2023

Interv Cardiol

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Background: Coronary vessels in women may have anatomical and histological particularities. The aim of this study was to investigate sex-specific characteristics and outcomes of patients with calcified coronary arteries in the Prepare-CALC (Comparison of Strategies to Prepare Severely Calcified Coronary Lesions) trial. Methods: The Prepare-CALC trial randomised patients with severe coronary calcification to coronary lesion preparation either using modified balloons (MB; cutting or scoring) or rotational atherectomy (RA). Results: Of 200 randomised patients, 24% were women. Strategy success in general was similar between women (93.8%) and men (88.2%; p=0.27). For men, strategy success was significantly more common with an RA-based strategy than an MB-based strategy (98.7% in the RA group versus 77.3% in the MB group, p<0.001), whereas for women there was no evidence of a significant difference in strategy success between RA and MB (95.7% in the RA group versus 92% in the MB group, p>0.99, p for interaction between sex and treatment strategy=0.03). Overall, significant complications such as death, MI, stent thrombosis, bypass operation and perforations were rare and did not differ significantly by gender or treatment strategy. Plaque rupture and disrupted calcified nodules were more common in women. Conclusion: In a well-defined patient population with severely calcified coronary arteries, lesion preparation with an RA-strategy was superior to an MB-strategy in men. For women, both RA and MB strategies appear to have a similar success rate, although definitive conclusions are limited due to the small number of women in the trial.

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“…A total of six observational studies with 3517 patients (2420 men and 1035 women) were included in the meta-analysis (Fig. 1) [15,[19][20][21][22][23]. In two studies (Kim et al and Lee et al), CA was performed by orbital atherectomy system and in four studies using rotational atherectomy (RA) [15,19].…”

Section: Resultsmentioning

confidence: 99%

Sex difference in clinical and procedural outcomes in patients undergoing coronary atherectomy: a systematic review and meta-analysis

Thandra

Pajjuru

Jhand

et al. 2022

Coronary Artery Disease

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Background Rotational and orbital coronary atherectomy (CA) are commonly utilized to treat complex calcified coronary lesions. We conducted a meta-analysis to evaluate sex differences in procedural complications and clinical outcomes after CA. Methods PubMed, Google Scholar, and Cochrane databases were searched for all studies comparing sex differences in procedural and clinical outcomes following CA. The outcomes of interest were procedural complications (coronary dissection, stroke, major bleeding, coronary perforation, cardiac tamponade, and slow or no flow in target vessel) and the clinical outcomes (including early mortality, mid-term all-cause mortality, stroke, myocardial infarction, and target vessel revascularization). Pooled risk ratios (RRs) with their corresponding 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel random-effects model. ResultsSix observational studies with 3517 patients (2420 men and 1035 women) were included in this metaanalysis. While there was no significant difference in the early mortality (RR, 1.14; 95% CI, 0.37-3.53; P = 0.83) between men and women, at a mean follow-up of 2.9 years, all-cause mortality was significantly higher in women (RR, 1.29; 95% CI, 1.11-1.49; P = 0.0009). Women had an increased risk of procedure-related stroke (RR, 3.98; 95% CI, 1.06-14.90; P = 0.04), coronary dissection (RR, 2.10; 95% CI, 1.23-3.58; P = 0.006), and bleeding (RR, 2.26; 95% CI, 1.30-3.93; P = 0.004), whereas the rates of coronary perforation, cardiac tamponade, and the risk of slow or no flow in the revascularized artery were similar in both. ConclusionIn our analysis, women undergoing CA are at increased risk of mid-term mortality and procedurerelated complications including stroke, coronary dissection, and major bleeding.

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Effect of Sex on Outcomes of Coronary Rotational Atherectomy Percutaneous Coronary Intervention (From the European Multicenter Euro4C Registry)

Cited by 6 publications

References 21 publications

The Procedural and Clinical Outcomes of Rotational Atherectomy in Patients Presenting With Acute Myocardial Infarction

The Procedural and Clinical Outcomes of Rotational Atherectomy in Patients Presenting With Acute Myocardial Infarction

Sex-specific Inequalities in the Treatment of Severely Calcified Coronary Lesions: A Sub-analysis of the PREPARE-CALC Trial

Sex difference in clinical and procedural outcomes in patients undergoing coronary atherectomy: a systematic review and meta-analysis

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