Abstract
Background There is a paucity of information about the gender differences in clinical outcomes of successful percutaneous coronary intervention (PCI) compared with medical therapy (MT) in patients with coronary chronic total occlusions (CTOs). Objectives We aimed to investigate the impact of gender on long-term clinical outcomes associated with successful CTO-PCI versus MT in patients with CTOs. Methods Between January 2007 and December 2016, a total of 1702 patients with ≥1 CTO were enrolled. After exclusion, 1294 patients with 1520 CTOs were analyzed and were divided into the female group (n = 304, 23.5%) and the male group (n = 990, 76.5%). The patients in the female or male group were assigned to a MT group or successful CTO-PCI group according to the treatment strategy. In the female group, they were divided into two groups: 177 patients in the MT group and 127 patients in the successful CTO-PCI group. In the male group, they were divided into two groups: 623 patients in the MT group and 367 patients in the successful CTO-PCI group. The primary outcome was cardiac death. The secondary outcome was major adverse cardiac event (MACE). Results The median overall follow-up duration was 3.6 (IQR, 2.1–5.0) years, there were no significant differences between the MT and successful CTO-PCI groups with respect to the prevalence of cardiac death (MT vs. successful PCI: 6.8% vs. 3.9%, p=0.287) and MACE (20.9% vs. 21.3%, p=0.810) in female patients. In the male group, the occurrence of cardiac death (MT vs. successful PCI: 6.6% vs. 3.8%, p=0.066) was similar between the two groups. The MACE rate (30.0% vs. 18.5%, p < 0.001) was significantly higher in the MT group. Heart failure (hazard ratio 3.40, 95% confidence interval 1.23–9.40, p=0.018) was an independent predictor of cardiac death in female patients. Conclusions Successful CTO-PCI was not associated with reduced risk of cardiac death compared with medical therapy alone in both female and male patients. However, men have a significant reduction in MACE rate after successful CTO-PCI. Aggressive CTO-PCI should be considered carefully among female patients.
Highlights
Gender differences have long been known to exist in the presentation and outcome of coronary artery disease (CAD)
Patients were grouped into the female group and the male group. e patients in the female group or male group were assigned to a medical therapy (MT) group or successful Chronic total occlusions (CTOs)-percutaneous coronary intervention (PCI) group according to the treatment strategy
They were divided into two groups: 177 in the MT group and 127 patients in the successful PCI group
Summary
Gender differences have long been known to exist in the presentation and outcome of coronary artery disease (CAD). Multiple studies indicate that female patients are less likely than male to be referred for invasive coronary angiography and to undergo revascularization, despite almost the same prevalence of coronary disease [1, 2]. Chronic total occlusions (CTOs) represent an important and unique subgroup of coronary lesions and have been identified in up to 18% of all patients referred for diagnostic angiography [3, 4]. Most studies reported that successful CTO percutaneous coronary intervention (PCI) is associated with symptomatic relief of angina, improvement in left ventricular function, quality of life, and a reduction in mortality compared with failed CTO-PCI [5,6,7]. A substantial portion of CTO patients are Journal of Interventional Cardiology treated with medical therapy (MT) alone instead of PCI [11, 12]
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