Percutaneous coronary intervention for chronic total occlusions in women showed no significant difference in adjusted 6-year MACE risk compared to men (aHR 1.15, 95% CI 0.76–1.74; p=0.517), but women had a higher adjusted risk of myocardial infarction (aHR 2.85, 95% CI 1.23–6.63; p=0.015).
Observational (n=928)
No
Does female sex affect the long-term risk of major adverse cardiac events in patients undergoing percutaneous coronary intervention for chronic total occlusions?
While overall long-term adjusted MACE rates following CTO-PCI are similar between sexes, women may face a significantly higher risk of subsequent myocardial infarction despite having less complex coronary anatomy.
Estimación del efecto: Unadjusted HR 1.51; adjusted HR 1.15 (95% CI Unadjusted 1.08–2.13; adjusted 0.76–1.74)
Tasa de eventos absoluta: 29.3% vs 22.1%
valor p: p=Unadjusted 0.017; adjusted 0.517
Background/Objectives: Sex-based differences in clinical profiles and outcomes following percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) remain poorly understood. We sought to examine the association between sex and long-term clinical outcomes following CTO-PCI in a contemporary real-world cohort. Methods: We conducted a retrospective study of 928 consecutive patients (788 men, 140 women) undergoing CTO-PCI at a high-volume centre between 2011 and 2024. The primary endpoint was a composite of major adverse cardiac events (MACE: all-cause death, myocardial infarction MI, or stroke) at a 6-year follow-up. To account for baseline differences, an Inverse Probability of Treatment Weighting (IPTW)-adjusted Cox regression analysis was performed. Results: Women were significantly older (69.7 ± 10 vs. 64.1 ± 10 years; p < 0.001) and had a higher prevalence of diabetes and hypertension. However, women exhibited lower angiographic complexity, with lower J-CTO scores (2 1–2 vs. 2 1–3; p < 0.001) and less frequent severe calcification or tortuosity. Technical and procedural success rates were comparable between sexes (85.4% vs. 86.7%; p = 0.695). Unadjusted MACE rates were higher in women (29.3% vs. 22.1%; hazard ratio (HR) 1.51, 95% CI: 1.08–2.13; p = 0.017). After adjustment, the female sex was no longer associated with the primary endpoint (aHR 1.15, 95% CI: 0.76–1.74; p = 0.517), but the risk of MI remained significantly higher in this group (aHR 2.85, 95% CI: 1.23–6.63; p = 0.015). Conclusions: CTO-PCI appeared to be equally safe and effective in women and men. Over long-term follow-up, although the overall adjusted MACE risk was similar between sexes, the female sex was associated with a higher risk for MI.
Gallo et al. (Thu,) conducted a observational in Adult patients (≥18 years) undergoing percutaneous coronary intervention for chronic total occlusions with at least one CTO lesion diagnosed, including patients with a high burden of cardiovascular comorbidities, median follow-up 6 years (n=928). Percutaneous coronary intervention for chronic total occlusions vs. Comparison by sex (male vs. female) was evaluated on Composite of major adverse cardiac events (MACE: all-cause death, myocardial infarction [MI], or stroke) at 6-year follow-up (Unadjusted HR 1.51; adjusted HR 1.15, 95% CI Unadjusted 1.08–2.13; adjusted 0.76–1.74, p=Unadjusted 0.017; adjusted 0.517). Percutaneous coronary intervention for chronic total occlusions in women showed no significant difference in adjusted 6-year MACE risk compared to men (aHR 1.15, 95% CI 0.76–1.74; p=0.517), but women had a higher adjusted risk of myocardial infarction (aHR 2.85, 95% CI 1.23–6.63; p=0.015).