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Title: Sex differences in procedural and clinical outcomes following rotational atherectomy
Authors: Ford, Tom ;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.G.;McEntegart, M.
Affliation: Central Coast Local Health District
Gosford Hospital
Issue Date: Feb-2020
Source: 95(2):232-241
Journal title: Catheterization and Cardiovascular Interventions : official journal of the Society for Cardiac Angiography & Interventions
Department: Cardiology
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.
DOI: 10.1002/ccd.28373
ISSN: 1522-1946
Publicaton type: Journal Article
Keywords: Cardiology
Cardiovascular Disease
Appears in Collections:Cardiology

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