Sex differences in procedural and clinical outcomes following rotational atherectomy

Abstract

Aim: Evaluate sex differences in procedural net adverse clinical events and long-term outcomes following rotational atherectomy (RA).Methods and Results: From August 2010 to 2016, 765 consecutive patients undergoing RA PCI were followed up for a median of 4.7 years. 285 (37%) of subjects were female. Women were older (mean 76 years vs. 72 years; p < .001) and had more urgent procedures (64.6 vs. 47.3%; p < .001). Females received fewer radial procedures (75.1 vs. 85.1%; p < .001) and less intravascular imaging guidance (16.8 vs. 25.0%; p = .008). After propensity score adjustment, the primary endpoint of net adverse cardiac events (net adverse clinical events: all-cause death, myocardial infarction, stroke, target vessel revascularization plus any procedural complication) occurred more often in female patients (15.1 vs. 9.0%; adjusted OR 1.81 95% CI 1.04-3.13; p = .037). This was driven by an increased risk of procedural complications rather than procedural major adverse cardiac events (MACE). Specifically, women were more likely to experience coronary dissection (4.6 vs. 1.3%; p = .008), cardiac tamponade (2.1 vs. 0.4%; p = .046) and significant bleeding (BARC ≥2: 5.3 vs. 2.3). Despite this, overall MACE-free survival was similar between males and females (adjusted HR 1.03; 95% CI 0.80-1.34; p = .81). Procedural complications during RA were associated with almost double the incidence of MACE at long-term follow-up (HR 1.92; 95% CI 1.34-2.77; p < .001).

Sex-related differences and rotational atherectomy: Analysis of 5 177 percutaneous coronary interventions based on a large national registry from 2014 to 2020

“…An analysis of RA use from 2014 to 2020 in the entire group of patients undergoing PCI, based on a large national registry, confirms that the upward trend in RA percentage among all PCI procedures continues [14,18]. Like in previously published articles, in the current analysis, we demonstrated that women treated with PCI and RA were older than men and presented acute coronary syndrome (ACS) more often [19]. While there were no significant differences in vascular access, in other publications, it was suggested that female patients were more often treated from femoral vascular access [19].…”

“…Like in previously published articles, in the current analysis, we demonstrated that women treated with PCI and RA were older than men and presented acute coronary syndrome (ACS) more often [19]. While there were no significant differences in vascular access, in other publications, it was suggested that female patients were more often treated from femoral vascular access [19]. According to multivariable analysis, a greater burden of periprocedural cardiovascular death and complications was presented in female patients, which is in accordance with the data from previously published papers [19].…”

“…While there were no significant differences in vascular access, in other publications, it was suggested that female patients were more often treated from femoral vascular access [19]. According to multivariable analysis, a greater burden of periprocedural cardiovascular death and complications was presented in female patients, which is in accordance with the data from previously published papers [19]. This might be, at least in part, a result of the more difficult treatment of coronary artery disease among women due to the higher percentage of diabetes and ACS, which are related, generally, to the higher risk of death.…”

SCAI Expert Consensus Statement on Sex-Specific Considerations in Myocardial Revascularization

“…Retrospective analyses of trial data evaluating RA have demonstrated that women are at increased risk of procedural complications and major adverse cardiac events (MACE) compared with men. 124 In a recent propensity matched series of 765 consecutive patients (37% women) undergoing RA followed for a median of 4.7 years, the primary endpoint of net adverse cardiac events (net adverse clinical events: all-cause death, myocardial infarction, stroke, and target vessel revascularization plus any procedural complication) occurred more often in women (15.1 vs. 9.0%; adjusted OR 1.81, 95% CI 1.04-3.13, p¼0.037). This was driven by an increased risk of procedural complications rather than procedural MACE.…”

Understanding the role of female sex in patients undergoing pci with rotational atherectomy

“…In line with these observations are data from a recent registry [11] showing that women had a higher rate of myocardial infarction at one year following complex PCI (even after adjusting for potential confounders), even though they present with less challenging lesions than men. Moreover, Ford et al [12] showed that women undergoing RA PCI are at greater risk of bleeding complications and coronary perforations leading to cardiac tamponade.…”