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Sex-related differences and rotational atherectomy: Analysis of 5 177 percutaneous coronary interventions based on a
Karol Sabatowski1, Krzysztof P Malinowski2, Zbigniew Siudak3
1Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
Insights
In patients undergoing rotational atherectomy (RA) for heavily calcified arteries, female sex is linked to higher rates of periprocedural complications and death. This sex-based disparity remained consistent over the study period.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Devices
Background:
- Percutaneous coronary interventions (PCI) with rotational atherectomy (RA) are used for severely calcified coronary arteries.
- Prognosis after RA differs significantly between sexes.
- Understanding sex-based trends and risks is crucial for patient outcomes.
Purpose of the Study:
- To analyze trends in the proportion of sexes undergoing RA over time.
- To compare demographic characteristics between male and female patients.
- To identify risk factors for periprocedural complications and mortality in RA patients.
Main Methods:
- Analysis of 751,113 PCI cases from the Polish National Registry (2014-2020).
- Inclusion of 5,177 patients (0.7%) treated with RA.
- Multivariable analysis to identify risk factors for complications and death.
Main Results:
- The proportion of RA procedures increased from 2014-2020.
- Men constituted the majority of RA patients (68.6%), with stable sex distribution over time.
- Women were older and experienced higher rates of periprocedural complications (3.45% vs. 2.31%) and death (0.68% vs. 0.17%).
Conclusions:
- Male predominance in RA procedures is consistent.
- Female sex is an independent risk factor for increased periprocedural mortality and complications after RA.
- Further research into sex-specific management strategies is warranted.
Background:
Patients undergoing percutaneous coronary interventions (PCI) with rotational atherectomy (RA) have massively calcified coronary arteries and their prognosis differs between sexes.
Aims:
The aim of the study was to evaluate the trends in the percentage of sexes in the subsequent years, to compare demographic characteristics between men and women, and to identify factors associated with the risk of periprocedural complications and death.
Methods:
We analyzed data on 751 113 patients treated with PCI between 2014 and 2020 from the Polish National Registry of Percutaneous Coronary Interventions (ORPKI). We extracted data on 5 177 (0.7%) patients treated with RA of whom 3 552 (68.6%) were men. To determine risk factors of periprocedural complications and death, a multivariable analysis was performed.
Results:
The proportion of PCIs involving RA increased between 2014 and 2020 (P <0.001). Almost twice as many RA procedures were performed on men (68.55%), and that proportion did not change in the following years. The female patients were older (75.2 [8.3] vs. 70.5 [9.2] years; P <0.001). When considering periprocedural complications, their overall rate (3.45% vs. 2.31%; P = 0.01) and death rate (0.68% vs. 0.17%; P = 0.006) were greater among women. Also, via multivariable analysis, female sex was found to be a risk factor for greater periprocedural mortality (P = 0.02) and overall complication rate (P = 0.007).
Conclusions:
The majority of patients treated with RA are men and sex-related distribution was stable during the analyzed period. Female sex is a risk factor for greater periprocedural complications and mortality in patients treated with RA.
