Gender Differences in Long-Term Outcomes of Medical Therapy and Successful Percutaneous Coronary Intervention for Coronary Chronic Total Occlusions.

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.

• Authors: Lei Guo, Haichen Lv, Lei Zhong, Jian Wu, Huaiyu Ding, Jiaying Xu, Rongchong Huang
• Journal: Journal of interventional cardiology (J Interv Cardiol) Vol. 2019 Pg. 2017958 ( 2019) ISSN: 1540-8183 [Electronic] United States
• PMID: 31772516 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2019 Lei Guo et al.

Chemical References

• Adrenergic beta-Antagonists
• Hypolipidemic Agents
• Nitrates
• Platelet Aggregation Inhibitors

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Age Factors
• Aged
• China (epidemiology)
• Coronary Occlusion (therapy)
• Female
• Follow-Up Studies
• Heart Failure (mortality)
• Humans
• Hypolipidemic Agents (therapeutic use)
• Male
• Middle Aged
• Nitrates (therapeutic use)
• Percutaneous Coronary Intervention
• Platelet Aggregation Inhibitors (therapeutic use)
• Retrospective Studies
• Sex Factors
• Vascular Calcification (mortality)