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, (doi: 10.1002/ccd.28373) (Early Online Publication)

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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:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Robertson, Dr Keith and Rocchiccioli, Dr John and McEntegart, Dr Margaret and Eteiba, Dr Hany and Shaukat, Dr Aadil and Ford, Tom 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 > Institute of Cardiovascular and Medical Sciences
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 2020
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
617771BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177RI CARDIOVASCULAR & MEDICAL SCIENCES
3014540CORonary MICrovascular Angina (CorMicA): a pilot trial with a nested MRI sub-studyColin BerryBritish Heart Foundation (BHF)PG/17/25/32884CAMS - Cardiovascular Science