Impact of Sex on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from a Multicenter US Registry

INTRODUCTION: The effect of sex on in-hospital outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. METHODS: Using data collected from 14 experienced U.S. centers between 2012 and 2016, we compared the clinical, angiographic, and procedural characteristics of 1,753 CTO PCIs performed in 1,718 patients by sex. RESULTS: Most patients were men (84.7%) with a mean age of 65.3±10 years. As compared with women, men presented for CTO PCI at a younger age (65.0±10 vs. 66.8±11 years, p=0.022), had higher J-CTO (2.54±1.23 vs. 2.35±1.28, p=0.045) and Progress-CTO (1.05±1.0 vs. 0.875±0.94, p=0.005) scores, longer lesions [30.0 (20.0, 50.0) mm vs. 28.0 (15.0, 40.0) mm, p=0.034] and more moderate to severe tortuosity (36.9% vs. 28.8%, p=0.016). They were also more likely to have had prior coronary artery bypass graft surgery (36.4% vs. 30.0%, p=0.046) and to undergo CTO PCI using the retrograde approach (41.0% vs. 32.6%, p=0.010). The final successful crossing strategy was more likely to be antegrade wire escalation in women (40.8% vs. 54.4%, p<0.001). Technical success was lower in men (88.0% vs. 92.6%, p=0.034), whereas procedural success (86.6% vs. 89.4%, p=0.232) and major adverse cardiovascular events (2.42% vs. 3.41%, p=0.348) were similar (Figure 1). CTO PCI in men was associated with longer procedural time, fluoroscopy time, increased use of contrast, and higher air kerma radiation dose. CONCLUSIONS: As compared with women, CTO PCI in men is associated with higher lesion complexity and lower technical success, but similar procedural success and similar incidence of major adverse cardiovascular events.