Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA.
Catheter Cardiovasc Interv. 2022 Nov;100(6):1010-1018. doi: 10.1002/ccd.30425. Epub 2022 Oct 25.
There are limited data describing gender differences in patients undergoing chronic total occlusion (CTO) percutaneous coronary interventions (PCI).
We compared baseline clinical and angiographic characteristics and procedural outcomes between men and women among 9457 CTO PCIs performed at 38 centers between 2012 and 2022.
A total of 7687 (81%) men and 1770 (19%) women were treated. Women were older, more likely to have comorbidities such as diabetes, hypertension and peripheral arterial disease, and had higher left ventricular ejection fraction. The most common CTO target vessel was the right coronary artery for both men (53%) and women (52%), although the left anterior descending artery was more frequently the target vessel among women (31% vs. 25%; p < 0.001). The J-CTO score (2.4 ± 1.3 vs. 2.2 ± 1.2; p < 0.001) as well as the PROGRESS-CTO score (1.3 ± 1.0 vs. 1.1 ± 1.0; p < 0.001) were higher among men. In female patients, antegrade wiring was more frequently the initial crossing strategy (87.6% vs. 82.4%; p < 0.001) and was more successful in crossing the target lesion (62.7% vs. 54.0%; p < 0.001) compared with men. Interventions in men required longer procedure time and fluoroscopy time, as well as higher air kerma radiation dose and contrast volume when compared to women. Technical (89% vs. 86%; p < 0.001) and procedural (87% vs. 84%; p = 0.003) success rates were higher among women. In-hospital major adverse cardiovascular events (MACE) were also higher in women (2.9% vs. 1.8%; p < 0.001).
Women undergoing CTO PCI had higher technical and procedural success rates, but also higher in-hospital MACE compared with men.
目前关于接受慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的患者中性别差异的数据有限。
我们比较了 2012 年至 2022 年间在 38 个中心进行的 9457 例 CTO PCI 中男性和女性患者的基线临床和血管造影特征以及手术结果。
共治疗了 7687 例（81%）男性和 1770 例（19%）女性。女性年龄更大，更可能患有合并症，如糖尿病、高血压和外周动脉疾病，且左心室射血分数更高。对于男性（53%）和女性（52%），最常见的 CTO 靶血管均为右冠状动脉，但女性中更常见的靶血管为左前降支（31%比 25%；p<0.001）。男性的 J-CTO 评分（2.4±1.3 比 2.2±1.2；p<0.001）和 PROGRESS-CTO 评分（1.3±1.0 比 1.1±1.0；p<0.001）均较高。在女性患者中，正向导丝更常作为初始穿线策略（87.6%比 82.4%；p<0.001），且在穿通靶病变方面更成功（62.7%比 54.0%；p<0.001）。与女性相比，男性的手术时间和透视时间更长，空气比释动能辐射剂量和造影剂用量也更高。女性的技术成功率（89%比 86%；p<0.001）和手术成功率（87%比 84%；p=0.003）更高。女性住院期间的主要不良心血管事件（MACE）发生率也更高（2.9%比 1.8%；p<0.001）。
与男性相比，接受 CTO PCI 的女性患者的技术和手术成功率更高，但住院期间 MACE 发生率也更高。
