Gender differences in long-term clinical outcomes after percutaneous coronary intervention of chronic total
Bimmer E Claessen1, Alaide Chieffo, George D Dangas
1Cardiovascular Institute, Mount Sinai Medical Center, One Gustav L Levy Place, Box 1030, New York, NY 10029, USA.
Insights
Percutaneous coronary intervention for chronic total occlusion (CTO PCI) appears more beneficial for men than women. However, CTO PCI is safe and feasible for women and warrants further investigation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Gender differences in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) are not well understood.
- CTO PCI is a complex procedure with limited data on outcomes stratified by sex.
Purpose of the Study:
- To compare baseline characteristics, procedural success, and long-term clinical outcomes between men and women undergoing CTO PCI.
- To evaluate the impact of gender on the benefits of successful CTO PCI.
Main Methods:
- A retrospective analysis of 1791 patients (1852 CTOs) who underwent CTO PCI across three international centers (1998-2007).
- Comparison of baseline demographics, procedural success (residual stenosis <50%), and 5-year clinical event rates (mortality, need for coronary artery bypass graft surgery, major adverse cardiac events) between male and female patients.
Main Results:
- Women constituted 14% of the study population.
- Procedural success rates were similar between genders, but successful CTO PCI was associated with a greater reduction in major adverse cardiac events (MACE) in men compared to women.
- Successful CTO PCI reduced mortality and the need for coronary artery bypass graft (CABG) surgery in men, with a trend towards reduced CABG need in women.
Conclusions:
- Successful CTO PCI demonstrated a greater benefit in reducing MACE for men compared to women.
- CTO PCI is safe and feasible in women, suggesting it should be considered more frequently.
- Further randomized controlled trials are necessary to precisely ascertain the impact of CTO PCI in both genders.
Introduction:
Little is known about gender differences among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).
Methods:
A total of 1791 patients with 1852 CTOs underwent PCI at 3 centers in the United States, Italy, and South Korea between 1998 and 2007. We compared baseline characteristics, procedural success rates (residual stenosis <50%), and 5-year clinical event rates in male and female patients.
Results:
A total of 1534 men (86%) and 248 women (14%) were treated. After multivariate adjustment, procedural success rates were similar in men and women. The median follow-up duration was 2.9 years (interquartile range, 1.5-4.6 years). Successful CTO PCI was associated with reduced mortality (5.7% vs 9.2%; P<.01) and a reduced need for coronary artery bypass graft (CABG) surgery (3.1% vs 14.1%; P<.01) in male patients. In female patients, there was a trend toward a lower need for CABG after successful CTO PCI (4.0% vs 6.9%; P=.09). Rates of major adverse cardiac events (MACE; death, myocardial infarction, and CABG) were lower after successful PCI in both men and women (men, 13.1% vs 24.4% and P<.01; women, 12.3% vs 15.5% and P=.04). There was a significant interaction between gender and procedural success in terms of MACE (P<.01), indicating men had a greater reduction in MACE rate after successful CTO PCI compared with women.
Conclusion:
Our study suggested a greater benefit of a successful CTO intervention in men compared with women. A minority of patients (14%) were women. CTO PCI in women is safe and feasible and should probably be considered more often. A randomized controlled trial is needed to accurately investigate the impact of CTO PCI in both men and women.
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