Gender differences in percutaneous coronary intervention for chronic total occlusions from the ERCTO study

Abstract

Background: Gender-specific data addressing percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) in female patients are scarce and based on small sample size studies.Aims: We aimed to analyze gender-differences regarding in-hospital clinical outcomes after CTO-PCI.Methods: Data from 35,449 patients enrolled in the prospective European Registry of CTOs were analyzed. The primary outcome was the comparison of procedural success rate in the two cohorts (women vs. men), defined as a final residual stenosis less than 20%, with Thrombolysis In Myocardial Infarction grade flow = 3. In-hospital major adverse cardiac and cerebrovascular events (MACCEs) and procedural complications were deemed secondary outcomes.Results: Women represented 15.2% of the entire study population. They were older and more likely to have hypertension, diabetes, and renal failure, with an overall lower J-CTO score. Women showed a higher procedural success rate (adjusted OR [aOR] = 1.115, confidence interval [CI]: 1.011-1.230, p = 0.030). Apart from previous myocardial infarction and surgical revascularization, no other significant gender differences were found among predictors of procedural success. Antegrade approach with true-to-true lumen techniques was more commonly used than retrograde approach in females. No gender differences were found regarding inhospital MACCEs (0.9% vs. 0.9%, p = 0.766), although a higher rate of procedural complications was observed in women, such as coronary perforation (3.7% vs. 2.9%, p < 0.001) and vascular complications (1.0% vs. 0.6%, p < 0.001).Conclusions: Women are understudied in contemporary CTO-PCI practice. Female sex is associated with higher procedural success after CTO-PCI, yet no sex differences were found in terms of in-hospital MACCEs. Female sex was associated with a higher rate of procedural complications.chronic total occlusion, female sex, gender differences, major adverse cardiac and cerebrovascular events, percutaneous coronary intervention How to cite this article: Avran A, Zuffi A, Gobbi C, et al.Gender differences in percutaneous coronary intervention for chronic total occlusions from the ERCTO study. Catheter

Is there a woman paradox? Commentary on the Gender differences in percutaneous coronary intervention for chronic total occlusions from the ERCTO study

“…3 Antegrade wiring was also the more frequent initial crossing strategy in women, who also had higher technical and procedural success, and in whom more complex strategies of retrograde and antegrade dissection and reentry were less used. 3 In this ERCTO registry report, female sex was an independent predictor of both coronary perforations and vascular complications on multivariate analysis, 1 reflecting similar trends previously reported among women undergoing CTO PCI, despite less complex coronary lesion anatomies and use of antegrade techniques. 3,4 Higher coronary perforations could be a result of potential use of oversized balloons and stents in smaller coronary arteries with greater degree of calcification in a more elderly female cohort.…”

“…Many of these findings can be explained by the CTO anatomy and complexity, which seemed to have dictated CTO PCI strategy, left to operators' discretion. Indeed, a sex‐stratified analysis showed no differences in procedural success predictors related to coronary anatomy or CTO characteristics in the two cohorts 1 …”

“…Indeed, a sex-stratified analysis showed no differences in procedural success predictors related to coronary anatomy or CTO characteristics in the two cohorts. 1 Women were more likely to present with a tapered proximal cap, shorter lesion length, and fewer moderate-to-severe calcifications. As per collateral connection (CC) grading, women more frequently had threadlike CC (CC1), while men presented with a higher rate of sidebranch like connections (CC2).…”

“…Consequently, consumables including total contrast volume, fluoroscopic, and procedural time were significantly lower in women. 1 Expert Article Analysis for: Gender differences in percutaneous coronary intervention for chronic total occlusions from the ERCTO study A 2021 meta-analysis 2 and the recently published PROGRESS-CTO registry (9457 participants, 19% women) reported similar sex differences in CTO PCI. 3 The J-CTO score in the smaller, but more contemporary PROGRESS-CTO registry, was slightly higher than in ERCTO, although women still had lower J-CTO scores overall (2.4 ± 1.3 vs. 2.2 ± 1.2 for men vs. women; p < 0.001).…”

“…As increasingly more chronic total occlusion (CTO) interventions are undertaken, data on sex differences in the complexity of the coronary anatomy, procedural success, and cardiovascular outcomes are important parameters to capture. In this issue of Catheterization and Cardiovascular Interventions , Avran et al report sex differences of 35,449 patients from the prospective European Registry of CTOs (ERCTO), of whom 15.2% were women 1 . Despite this heavily skewed sex distribution, the large number of patients in this registry permits a reasonable comparison of baseline characteristics, procedural details, and outcomes.…”