21 Nov Women Undergoing Stent Surgery for Total Coronary Occlusions Tend To Be Older and Have More Complications
MedicalResearch.com Interview with:
Dr James Spratt Bsc, MD, FRCP, FESC, FACC
Spire Edinburgh Hospitals and Spire Murrayfield Edinburgh
Spire Shawfair Park Hospital
MedicalResearch.com: What is the background for this study?
Response: Gender differences exist between male and female patients following routine PCI but data regarding these differences in Chronic Total Occlusions (CTO) Percutaneous Coronary Intervention (PCI) is limited. We maintain a dedicated national (United Kingdom) prospective CTO database contributed to by dedicated CTO PCI operators (lifetime CTO PCI >300). We retrospectively analysed this database from 2011-2015 to compare outcomes and characteristics of male versus female patients undergoing CTO PCI. We attempted to limit the bias of this observational study by propensity matched analysis.
MedicalResearch.com: What are the main findings?
Response: We demonstrated that although female patients formed only 20% of the cohort, they were more likely to be older at presentation for CTO Percutaneous Coronary Intervention (PCI) (45% of the matched cohort of females were >70 years of age) with similar success rates as their male counterparts but with an increased risk of in-hospital complications (unmatched: 10% females versus 4.45% males, p=0.0012 and matched 9.87% females versus 3.86% males, p=0.0032) including bleeding, contrast induced nephropathy and coronary perforation. This occurred despite the fact that the female patients demonstrated a trend towards less complex CTOs.
Over half of all complications that occurred were bleeding related. Femoral access site with larger sheaths (>6 French size) in female patients was associated with an increased risk of bleeding (unmatched 6.9% females vs 3.0% males p= 0.01 and matched 6.3% females vs 2.1% males, p=0.015).
The final CTO PCI strategy was less commonly retrograde (retrograde dissection re-entry or RDR) in the female compared to the male group (both unmatched and matched cohorts) possibly due to smaller, tortuous and angulated collateral channels. Increased coronary perforation was observed in female compared to male patients during CTO PCI. We demonstrated a correlation between coronary perforation and the presence of calcification in the CTO artery.
Contrast Induced Nephropathy was more frequently observed in female patients especially those who underwent >1 CTO PCI procedure compared to male patients.
MedicalResearch.com: What should readers take away from your report?
Response: Increased awareness of these complications could potentially influence management decisions during CTO PCI in these patients namely – selection of access site (for e.g. utilising the radial artery for one access) and sheath size (≤6 Fr), need for pre-hydration and interventional tools/technique choices to minimise the occurrence of complications in female patients undergoing CTO PCI.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future studies to be considered include assessment of an ideal pre-hydration regime especially in women undergoing repeat CTO PCI procedures. We may also consider re-analysis of our database after 12 months to assess the impact of our findings.
MedicalResearch.com: Is there anything else you would like to add?
Response: This is one of the first studies to compare female and male patients undergoing Chronic Total Occlusions PCI. Success rates in CTO PCI have increased over the last decade and operators continue to take on more complex cases. Our study contributes to an increased awareness of complications especially in older female patients and potential management decisions which might minimise the risks.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Gender Differences in Long-Term Clinical Outcomes After Percutaneous Coronary Intervention of Chronic Total Occlusions
BE Claessen et al. J Invasive Cardiol 24 (10), 484-488. 10 2012.
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