Gender Differences in Outcomes After PCI of Chronic Occlusions
Gender Differences in Outcomes After PCI of Chronic Occlusions
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.
Coronary chronic total occlusion (CTO) is detected on diagnostic coronary angiography in approximately 30% of patients. However, only an estimated 15% of patients with a CTO undergo an attempt to revascularize a CTO by percutaneous coronary intervention (PCI) and patients are often referred for bypass surgery. A number of advances in guidewire, microcatheter and drug-eluting stent (DES) technology have made these notoriously complex lesions realistic targets for PCI. Recent meta-analyses and large registries have shown that successful CTO PCI is associated with symptom relief, a reduction in long-term mortality, and a lower need for coronary artery bypass graft (CABG) surgery.
Currently, there are no studies investigating the impact of gender on clinical outcomes after PCI of CTOs. Results of clinical studies investigating differences in outcomes after PCI in male and female patients have yielded inconclusive results. Therefore, we investigated the impact of gender on long-term clinical outcomes after CTO PCI in the large Multinational CTO Registry.
Abstract and Introduction
Abstract
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.
Introduction
Coronary chronic total occlusion (CTO) is detected on diagnostic coronary angiography in approximately 30% of patients. However, only an estimated 15% of patients with a CTO undergo an attempt to revascularize a CTO by percutaneous coronary intervention (PCI) and patients are often referred for bypass surgery. A number of advances in guidewire, microcatheter and drug-eluting stent (DES) technology have made these notoriously complex lesions realistic targets for PCI. Recent meta-analyses and large registries have shown that successful CTO PCI is associated with symptom relief, a reduction in long-term mortality, and a lower need for coronary artery bypass graft (CABG) surgery.
Currently, there are no studies investigating the impact of gender on clinical outcomes after PCI of CTOs. Results of clinical studies investigating differences in outcomes after PCI in male and female patients have yielded inconclusive results. Therefore, we investigated the impact of gender on long-term clinical outcomes after CTO PCI in the large Multinational CTO Registry.
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