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Sex-based differences in chronic total occlusion management and long-term clinical outcomes
Eduardo Josué Flores-Umanzor1, Pedro L Cepas-Guillen1, Guillem Caldentey2
1Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain.
Insights
Female sex is linked to worse outcomes in chronic total occlusion (CTO) management. Women with CTO face higher mortality rates and are less likely to receive optimal treatment, highlighting a significant sex disparity in cardiovascular care.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Coronary artery disease (CAD) exhibits known sex differences in presentation and outcomes.
- Chronic total occlusion (CTO) represents a complex subset of CAD with unique management challenges.
Purpose of the Study:
- To investigate and compare sex-based disparities in the management of CTO.
- To evaluate long-term clinical outcomes in relation to sex and CTO treatment strategies.
Main Methods:
- Retrospective analysis of 1248 consecutive patients diagnosed with CTO between 2010 and 2014.
- Data collection included demographics, clinical characteristics, and treatment strategies (Medical Therapy alone vs. other).
- All-cause and cardiac mortality were assessed over a median follow-up of 4.03 years.
Main Results:
- Women (16%) were older, had higher rates of type 2 diabetes, and lower ejection fraction than men.
- Despite higher rates of severe ischemia, women were more frequently treated with medical therapy (MT) alone (57% vs. 51%).
- Female sex was an independent predictor of higher cardiac mortality (HR 1.67) and all-cause mortality, irrespective of treatment.
Conclusions:
- A significant sex disparity exists in CTO treatment and long-term outcomes.
- Female sex is an independent risk factor for adverse cardiac events in CTO patients.
- Further research is warranted to elucidate the mechanisms behind these observed sex differences and to optimize management strategies for women with CTO.
Background:
Sex differences in coronary artery disease presentation and outcomes have been described. The aim of this study was to compare sex disparities in chronic total occlusion (CTO) management and long-term outcomes.
Methods:
All consecutive patients with at least one CTO diagnosed in our center between 2010 and 2014 were included. Demographic and clinical data were registered. All-cause and cardiac mortality were assessed during a median follow-up of 4.03 years (IQR 2.6-4.8).
Results:
A total of 1248 patients (67.3 ± 10.9 years; 16% female) were identified. Women were older, had a higher prevalence of type 2 DM and a lower ventricle ejection fraction compared to men (p < .05). Although women had major proportion of positive result for severe ischemia-viability test (86% vs. 74%; p = .01), they were more often treated with MT alone compared to male (57% vs 51%; p = .02). During follow-up, 386 patients (31%) died. Women presented a higher rate of all-cause and cardiac mortality, and hospitalizations for heart failure independently of treatment strategy, compared to men (p < .001). In multivariable analysis female sex was associated with higher cardiac mortality [HR 1.67, 95% CI 1.10-2.57; p < .001]. Among women, the independent predictors for all-cause and cardiac mortalities were age, MT of the CTO and ACEF (age, creatinin and ejection fraction) score.
Conclusions:
A significant sex gap regarding CTO treatment was observed. Female sex was an independent predictor for cardiac mortality at long-term follow-up. More data are needed to support these findings.
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