Sex‐based differences in bleeding and long‐term adverse events after percutaneous coronary intervention in older patients with coronary artery disease

Xu, Na; Tang, Xiaofang; Zhao, Xueyan; Chen, Jue; Gao, Zhan; Qiao, Shubin; Yang, Yuejin; Gao, Runlin; Xu, Bo; Yuan, Jinqing

doi:10.1111/joic.12500

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…Women enrolled in this study were older and had more co‐morbidities when compared to men. Similar differences in baseline demographic characteristics have been observed in trials of stable angina and acute coronary syndromes . Almost half of the female patients in the study were diabetic and 19.4% of the patients had underlying chronic kidney disease.…”

Section: Discussionsupporting

confidence: 67%

“…Similar differences in baseline demographic characteristics have been observed in trials of stable angina and acute coronary syndromes. 18,19 Almost half of the female patients in the study were diabetic and 19.4% of the patients had underlying chronic kidney disease. Women referred for CTO PCI in this study were less likely to have had CABG.…”

Section: Discussionmentioning

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: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

A sex stratified outcome analysis from the OPEN‐CTO registry

Pershad

Gulati

Karmpaliotis

et al. 2018

Cathet Cardio Intervent

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“…The results of this review demonstrate several trends in revascularization. First, females demonstrate statistically significant increased rates of adverse events and mortality post PCI and CABG [11,12,15,22,24–26,29,30,32–34]. This is in keeping with the previous and current literature demonstrating inferior outcomes for females when compared to males postcardiac surgery and revascularization [7,8,10,14,41].…”

Section: Discussionsupporting

confidence: 87%

“…Included were retrospective analysis, prospective observational studies, trial, and systematic reviews. All data included were collected from 2000 to 2018 [11,[15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Average rates of mortality and morbidity were compiled and averaged based on exact and approximated values from each study.…”

Section: Overview Of Percutaneous Coronary Intervention Trials Compar...mentioning

confidence: 99%

Review of the differences in outcomes between males and females after revascularization

EL‐Andari

Bozso

Kang

et al. 2021

Current Opinion in Cardiology

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Purpose of reviewThis review aims to compare outcomes of males and females undergoing coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), off-pump CABG (OPCAB), minimally invasive direct CABG (MIDCAB), and robotic total endoscopic CABG (TECAB). Recent findingsFemales demonstrated increased rates of morbidity and mortality post PCI and CABG. In studies that performed risk adjustments, these differences were reduced. Although inferior outcomes were observed for females in some measures, generally outcomes between males and females were comparable post OPCAB, MIDCAB, and TECAB SummaryPrevious literature has demonstrated that females undergoing coronary revascularization experience inferior postoperative outcomes when compared to their male counterparts. The discrepancies between males and females narrow, but do not disappear when preoperative risks are accounted for and when considering minimally invasive approaches such as MIDCAB, OPCAB, and TECAB. Minimally invasive cardiac surgery has demonstrated numerous benefits with reduced morbidity, mortality, and shorter recovery times. In patients with increased comorbidities, minimally invasive approaches confer a greater advantage. As females often fall within this category, it is paramount that the diagnosis and referral process be optimized to account for preoperative differences to provide the most beneficial approach if the disparity between the sexes is to be addressed.

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“…Xu et al reported that compared to males, females undergoing PCI had a high risk of bleedings at two-years follow-up. 36 Wanha et al also found that although the 1-year bleeding risk between females and males was similar after PCI therapy, females experienced a higher risk of in-hospital bleeding events. 37 Extending prior reports, the current study was also focused on elucidating the factors associated with the gender-disparities in bleeding events.…”

Section: Discussionmentioning

confidence: 95%

Gender-Disparities in the in-Hospital Clinical Outcome Among Patients with Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention

Wang¹,

S²,

Mo³

et al. 2022

IJGM

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Purpose The current study was to evaluate the gender-disparities in the in-hospital thrombotic and bleeding events among patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI). Patients and Methods Patients with CKD undergoing PCI were retrospectively enrolled. Baseline characteristics, and thrombotic and bleeding events occurred during hospitalization were collected and compared by gender. Results Compared to males (n = 558), females (n = 402) were older and more likely to have diabetes mellitus (37.1% vs 29.7%). Females had a lower estimated glomerular filtration rate (eGFR; 51.2 ± 7.9 vs 54.6 ± 5.1 mL/min/1.73m 2 ) and were more likely to undergo urgent PCI (66.7% vs 60.2%) and use glycoprotein IIb/IIIa inhibitor (15.4% vs 7.5%) at peri-PCI period. Compared to males, females had a higher rate of in-hospital mortality which was due to thrombotic events (9.0% vs 3.4%). Females also had a higher rate of moderate-to-severe hemorrhage (8.0% vs 3.2%). After multivariable adjustment, diabetes mellitus (odds ratio [OR] 1.15 and 95% confidence interval [CI] 1.07–1.29) and acute coronary syndrome (ACS) presentation (OR 1.53 and 95% CI 1.34–1.93) were associated with gender-disparities in composite thrombotic events. Ageing (OR 1.10 and 95% CI 1.02–1.33), diabetes mellitus (OR 1.21 and 95% CI 1.07–1.40) and glycoprotein IIb/IIIa inhibitor use (OR 1.13 and 95% CI 1.02–1.28) were associated with composite bleeding events. Conclusion Females with CKD undergoing PCI had a higher risk of experiencing in-hospital thrombotic and bleeding events than males.

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Sex‐based differences in bleeding and long‐term adverse events after percutaneous coronary intervention in older patients with coronary artery disease

Abstract: We found that older women undergoing PCI were at increased risk of 2-year bleeding compared with men. Further dedicated studies are needed to confirm these findings.

Cited by 5 publications

References 23 publications

A sex stratified outcome analysis from the OPEN‐CTO registry

A sex stratified outcome analysis from the OPEN‐CTO registry

Review of the differences in outcomes between males and females after revascularization

Gender-Disparities in the in-Hospital Clinical Outcome Among Patients with Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention

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