Sex differences in clinical profile and outcome after percutaneous coronary intervention for chronic total occlusion
Shoaib, Ahmad Sharma, Vinoda Spratt, James C Wilson, Simon Hussain, Shazia T Velagapudi, Poonam Siller-Matula, Jolanta M Rashid, Muhammad Ludman, Peter Cockburn, James
Shoaib, Ahmad
Sharma, Vinoda
Spratt, James C
Wilson, Simon
Hussain, Shazia T
Velagapudi, Poonam
Siller-Matula, Jolanta M
Rashid, Muhammad
Ludman, Peter
Cockburn, James
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Affiliation
Keele University; Sandwell and West Birmingham NHS Trust; St George's University Hospital NHS Trust; University Hospitals of Leicester NHS Trust; et al.
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Publication date
2022-12-16
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Abstract
Background: There are limited data around sex differences in the risk profile, treatments and outcomes of percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) lesions in contemporary interventional practice. We investigated the impact of sex on clinical and procedural characteristics, complications and clinical outcomes in a national cohort. Methods & results: We created a longitudinal cohort (2006-2018, n = 30,605) of patients with stable angina who underwent CTO PCI in the British Cardiovascular Intervention Society (BCIS) database. Clinical, demographic, procedural and outcome data were analysed in two groups stratified by sex: male (n = 24,651), female (n = 5954). Female patients were older (68 vs 64 years, P < 0.001), had higher prevalence of diabetes mellitus (DM), hypertension (HTN) and prior stroke. Utilization of intravascular ultrasound (IVUS), drug eluting stents (DES), radial or dual access and enabling strategies during CTO PCI were higher in male compared to female patients. Following multivariable analysis, there was no significant difference in in-patient mortality (adjusted odds ratio (OR):1.40, 95 % CI: 0.75-2.61, P = 0.29) and major cardiovascular and cerebrovascular events (MACCE) (adjusted OR: 1.01, 95 % CI: 0.78-1.29, P = 0.96). The crude and adjusted rates of procedural complications (adjusted OR: 1.37, 95 % CI: 1.23-1.52, P < 0.001), coronary artery perforation (adjusted OR: 1.60, 95 % CI: 1.26-2.04, P < 0.001) and major bleeding (adjusted OR: 2.06, 95 % CI: 1.62-2.61, P < 0.001) were higher in women compared with men. Conclusion: Female patients treated by CTO PCI were older, underwent lesser complex procedures, but had higher adjusted risk of procedural complications with a similar adjusted risk of mortality and MACCE compared with male patients.
Citation
Shoaib A, Sharma V, Spratt JC, Wilson S, Hussain ST, Velagapudi P, Siller-Matula JM, Rashid M, Ludman P, Cockburn J, Kinnaird T, Mamas MA; British Cardiovascular Intervention Society (BCIS); National Institute for Cardiovascular Outcomes Research (NICOR). Sex Differences in Clinical Profile and Outcome After Percutaneous Coronary Intervention for Chronic Total Occlusion. Cardiovasc Revasc Med. 2023 Apr;49:34-41. doi: 10.1016/j.carrev.2022.12.00
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Article