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Directional coronary atherectomy in women compared with men
H D Movsowitz1, R P Emmi, A Manginas
1Division of Cardiology, Albert Einstein Medical Center, Temple University School of Medicine, Philadelphia, Pennsylvania.
Clinical Cardiology
|November 1, 1994
Summary
Procedural success rates for directional coronary atherectomy (DCA) are lower in women, primarily due to smaller coronary artery size, not gender itself. Optimizing patient selection for DCA in vessels over 2.5 mm can improve outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- The influence of patient gender on the procedural outcomes of directional coronary atherectomy (DCA) remains a subject of debate.
- Previous studies have yielded conflicting results regarding the efficacy and safety of DCA in women versus men.
Purpose of the Study:
- To investigate the impact of gender on the procedural success and complication rates of directional coronary atherectomy (DCA).
- To identify predictors of procedural outcome in patients undergoing DCA, specifically examining the role of coronary vessel size and gender.
Main Methods:
- A retrospective analysis of 373 consecutive patients (418 lesions) who underwent directional coronary atherectomy (DCA).
- Comparison of procedural success rates, complication profiles, and patient demographics between female and male patients.
- Multivariate analysis to determine independent predictors of poor procedural outcome.
Main Results:
- Procedural success rates were significantly lower in women (72.7%) compared to men (82.9%).
- Women had significantly smaller coronary arteries (2.5 mm vs. 2.7 mm) and were older than men.
- Small coronary vessel size (< 2.5 mm) was identified as an independent predictor of poor procedural outcome, more so than female gender.
- Inability to engage the coronary ostium and cross the lesion was more frequent in women.
- Major ischemic complication rates were similar, but groin complications were higher in women.
Conclusions:
- Female gender itself is not an independent predictor of poor DCA procedural outcome; rather, smaller coronary vessel size is the key factor.
- Procedural success rates in women with coronary vessels >= 2.5 mm were comparable to those in men.
- Careful patient selection, focusing on coronary vessel diameter greater than 2.5 mm, is crucial for improving DCA outcomes in women.