Gender differences in long-term clinical outcomes after percutaneous coronary intervention of chronic total occlusions.

Abstract

INTRODUCTION: Little is known about gender differences among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). METHODS: A total of 1791 patients with 1852 CTOs underwent PCI at 3 centers in the United States, Italy, and South Korea between 1998 and 2007. We compared baseline characteristics, procedural success rates (residual stenosis <50%), and 5-year clinical event rates in male and female patients. RESULTS: A total of 1534 men (86%) and 248 women (14%) were treated. After multivariate adjustment, procedural success rates were similar in men and women. The median follow-up duration was 2.9 years (interquartile range, 1.5-4.6 years). Successful CTO PCI was associated with reduced mortality (5.7% vs 9.2%; P<.01) and a reduced need for coronary artery bypass graft (CABG) surgery (3.1% vs 14.1%; P<.01) in male patients. In female patients, there was a trend toward a lower need for CABG after successful CTO PCI (4.0% vs 6.9%; P=.09). Rates of major adverse cardiac events (MACE; death, myocardial infarction, and CABG) were lower after successful PCI in both men and women (men, 13.1% vs 24.4% and P<.01; women, 12.3% vs 15.5% and P=.04). There was a significant interaction between gender and procedural success in terms of MACE (P<.01), indicating men had a greater reduction in MACE rate after successful CTO PCI compared with women. CONCLUSION: Our study suggested a greater benefit of a successful CTO intervention in men compared with women. A minority of patients (14%) were women. CTO PCI in women is safe and feasible and should probably be considered more often. A randomized controlled trial is needed to accurately investigate the impact of CTO PCI in both men and women.