Abstract
It has been demonstrated that gender differences are related to different procedural and long-term clinical outcomes among a general patient population treated using percutaneous coronary interventions (PCI). The objective of our analysis was to conduct assessment regarding the relationship between gender and procedural outcomes in patients treated for PCI regarding chronic total occlusions (CTO), based on a large, real-life registry. Data used to conduct the following analysis was derived from the national registry of percutaneous coronary interventions (ORPKI), upheld in co-operation with the Association of Cardiovascular Interventions (AISN) of the Polish Cardiac Society. The study involved data procured from the registry within the period from January 2014 to December 2020. All subsequent CTO procedures recorded in the registry during that period were included in the analysis. We assessed the correlation between gender and the overall rate of periprocedural complications, procedure-related mortality, and success evaluated as TIMI flow grade 3 after the procedure by univariate and multivariable modeling. At the time of conducting our investigation, there were 162 existing and active CathLabs, at which 747,033 PCI procedures were carried out during the observational period. Of those, 14,903 (1.99%) were CTO-PCI procedures, and 3726 were women (25%). The percentage share between genders did not experience any significant changes during the consecutive years observed in the current analysis. Overall periprocedural complication rate was greater among women than men (3.45% vs. 2.31%, p = 0.02). A comparable relationship was noted for procedural mortality (0.7% vs. 0.2%, p = 0.006), while procedural success occurred more often in the case of women (69.3% vs. 65.2%, p < 0.001). Women were found to be more frequently affected by periprocedural complications (OR = 1.553; 95%CI: 1.212–1.99, p < 0.001) as well as procedural success (OR = 1.294; 95%CI: 1.151–1.454, p < 0.001), evaluated using multivariable models. Based on the current analysis performed on all-comer patients treated using PCI in CTO, women are affected by more frequent procedural complication occurrence as well as greater procedural success compared to men.
Highlights
Gender-related differences in the management, clinical presentation as well as outcomes among patients affected by coronary artery disease (CAD) undergoing percutaneous coronary interventions (PCIs) have been demonstrated in several aspects and are widely published [1]
chronic total occlusions (CTO) is defined in coronary angiography as coronary occlusion without the procedure of antegrade filling the distal vessel in a manner other than through collaterals evaluated via Thrombolysis in Myocardial Infarction at the 0-grade level
It was required that the occlusion duration be longer than 3 months, which was assessed from the time of clinical event onset, i.e., myocardial infarction (MI), abrupt onset or deterioration regarding chest
Summary
Gender-related differences in the management, clinical presentation as well as outcomes among patients affected by coronary artery disease (CAD) undergoing percutaneous coronary interventions (PCIs) have been demonstrated in several aspects and are widely published [1]. Various studies have been printed regarding differences in population characteristics, periprocedural outcomes and follow-up between sexes for patients treated with PCI within CTO [6–14]. Both in the general patient population with CAD and those regarded to angiographic studies, including patients undergoing treatment using PCI for CTO, women remain in the minority [15,16]. The prevalence of female gender in patients treated within CTO varies and usually, does not exceed 20% [7] Despite such a high frequency of CTO patients, presently, only a small percentage of them undergo percutaneous revascularization attempts, and in recent papers, their frequency amounts to several percent 3–4%, while in the past, this was even estimated at more than 10% [18,19]. Most of the studies published so far have been carried out on small patient groups treated using PCI in CTOs (with invasive selection criteria), and there are no existing studies among large numbers of patients, not selected in terms of operator advancement, center volume and experience, treatment success or other aspects
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