Sex differences in procedural and clinical outcomes following rotational atherectomy

Ford, T. J. et al. (2020) Sex differences in procedural and clinical outcomes following rotational atherectomy. Catheterization and Cardiovascular Interventions, 95(2), pp. 232-241. (doi: 10.1002/ccd.28373) (PMID:31264314) (PMCID:PMC7027486)

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). Conclusion: Women may be at greater risk of procedural complications following rotational atherectomy. These include periprocedural bleeding episodes and coronary perforation leading to cardiac tamponade. Despite this, the adjusted overall long‐term survival free of major adverse cardiac events was similar between males and females.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Robertson, Dr Keith and Rocchiccioli, Dr John and McEntegart, Dr Margaret and Eteiba, Professor Hany and Shaukat, Dr Aadil and Ford, Thomas and Petrie, Professor Mark and Oldroyd, Dr Keith and Berry, Professor Colin and Jackson, Dr Alice and Sidik, Ms Novalia
• Authors: Ford, T. J., Khan, A., Docherty, K. F., Jackson, A., Morrow, A., Sidik, N., Rocchiccioli, P., Good, R., Eteiba, H., Watkins, S., Shaukat, A., Lindsay, M., Robertson, K., Petrie, M., Berry, C., Oldroyd, K., and McEntegart, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Catheterization and Cardiovascular Interventions
• Publisher: Wiley
• ISSN: 1522-1946
• ISSN (Online): 1522-726X
• Published Online: 01 July 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Catheterization and Cardiovascular Interventions 95(2): 232-241
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
61777	1	BHF centre of excellence	Rhian Touyz	British Heart Foundation (BHF)	RE/13/5/30177	RI CARDIOVASCULAR & MEDICAL SCIENCES
301454	0	CORonary MICrovascular Angina (CorMicA): a pilot trial with a nested MRI sub-study	Colin Berry	British Heart Foundation (BHF)	PG/17/25/32884	CAMS - Cardiovascular Science