Alasnag Mirvat, Paradies Valeria, Ryan Nicola, Martinez Sara C
Cardiac Center, King Fahd Armed Forces Hospital Jeddah, Saudi Arabia.
Department of Cardiology, Maasstad Hospital Rotterdam, the Netherlands.
US Cardiol. 2023 Nov 23;17:e18. doi: 10.15420/usc.2022.21. eCollection 2023.
Complex percutaneous cardiac intervention (PCI) is a growing procedure in modern day cath labs. The treated population is often older, with multiple comorbidities, complex coronary anatomy, left ventricular dysfunction, and possibly concomitant valvular heart disease and/or cardiogenic shock. As such, PCI of bifurcations, chronic total occlusions, and atherectomy coronary interventions are becoming more common. The outcomes in terms of acute procedural success, procedure-related complications, and long-term mortality or heart failure hospitalizations are important to consider. Unfortunately, to date there is a paucity of data identifying sex and gender disparities following such interventions. With respect to bifurcation lesions, women usually have more comorbidities with less complex coronary anatomy. However, despite less complex anatomy, women have a significantly increased risk of MI. These differences are also noted with left main stem and multivessel disease, during which women appear to have a trend towards worse outcomes following PCI compared with coronary artery bypass grafting. Randomized trials have revealed that women present with increased cardiovascular risk factors, which may contribute to adverse longer-term outcomes. Revascularization of women with concomitant valvular heart disease is particularly challenging because the existing data are conflicted on not only the indication, but also the timing of revascularization. Similarly, women undergoing PCI of calcified lesions with drug-eluting stents have a worse clinical profile and remain at increased ischemic risk. The lower incidence of coronary calcification in women, combined with the under-representation of women in randomized trials, poses a real challenge when attempting to address safety and survival benefit in women undergoing complex interventions. This warrants dedicated trials exploring the safety and efficacy of complex interventions in women.
复杂经皮冠状动脉介入治疗（PCI）在现代导管室中越来越常见。接受治疗的人群通常年龄较大，伴有多种合并症、复杂的冠状动脉解剖结构、左心室功能障碍，还可能伴有瓣膜性心脏病和/或心源性休克。因此，分叉病变、慢性完全闭塞病变以及冠状动脉旋切介入治疗越来越普遍。急性手术成功率、手术相关并发症以及长期死亡率或心力衰竭住院率等结果是需要考虑的重要因素。不幸的是，迄今为止，缺乏关于此类干预后性别差异的数据。对于分叉病变，女性通常合并症更多，冠状动脉解剖结构相对不那么复杂。然而，尽管解剖结构不那么复杂，但女性发生心肌梗死的风险显著增加。在左主干和多支血管疾病中也存在这些差异，在此期间，与冠状动脉旁路移植术相比，女性PCI术后似乎有预后较差的趋势。随机试验表明，女性存在更多的心血管危险因素，这可能导致不良的长期预后。合并瓣膜性心脏病的女性进行血运重建尤其具有挑战性，因为现有数据不仅在血运重建的指征方面存在冲突，在时机方面也存在冲突。同样，接受药物洗脱支架治疗钙化病变的女性PCI术后临床情况较差，缺血风险仍然较高。女性冠状动脉钙化发生率较低，再加上女性在随机试验中的代表性不足，在试图解决接受复杂干预的女性的安全性和生存获益问题时构成了真正的挑战。这就需要专门的试验来探索复杂干预对女性的安全性和有效性。
