Sex-Based Differences in Long-Term Outcomes Following Percutaneous Coronary Intervention for Chronic Total Occlusions

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Outcomes Research

Background:

• Sex-based differences in clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) are not well understood.
• Real-world data on long-term outcomes following CTO-PCI stratified by sex is limited.

Purpose of the Study:

• To investigate the association between sex and long-term clinical outcomes after CTO-PCI.
• To compare the safety and effectiveness of CTO-PCI in men versus women.

Main Methods:

• Retrospective analysis of 928 patients undergoing CTO-PCI (2011-2024).
• Primary endpoint: Major adverse cardiac events (MACE) at 6-year follow-up.
• Inverse Probability of Treatment Weighting (IPTW)-adjusted Cox regression used to control for baseline differences.

Main Results:

• Women were older and had higher rates of diabetes and hypertension but lower angiographic complexity.
• Technical and procedural success rates were comparable between sexes.
• Unadjusted MACE rates were higher in women, but adjusted analysis showed no significant difference in overall MACE. However, women had a significantly higher risk of myocardial infarction (MI) post-procedure.

Conclusions:

• CTO-PCI demonstrates comparable safety and effectiveness in women and men regarding overall long-term MACE.
• Despite similar overall adjusted MACE, women undergoing CTO-PCI face a significantly higher risk of myocardial infarction.