Hamzaraj Kevin, Demirel Caglayan, Domanig Antonia, Graf Senta, Gyöngyösi Mariann, Hengstenberg Christian, Frey Bernhard, Hemetsberger Rayyan
Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria.
J Clin Med. 2025 Jun 25;14(13):4496. doi: 10.3390/jcm14134496.
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains a complex procedure that requires advanced operator skills and dedicated devices. Despite increased success rates in experienced centers, the in-hospital complications of CTO PCI remain notably high. Female patients undergoing CTO PCI are reported to experience higher rates of complications; however, the underlying mechanisms remain inadequately defined. We prospectively enrolled consecutive patients undergoing CTO PCI at our university-affiliated tertiary care center over 4 years (2018-2021), aiming to elucidate sex-based disparities in in-hospital complications. In addition, we investigated the impact of angiographic femoral artery metrics on in-hospital complications. Among 271 patients who underwent antegrade or retrograde CTO PCI, 222 (81.9%) were men and 49 (18.9%) women. Female patients were significantly older (67 ± 11 vs. 72 ± 12 years; = 0.005) and had a comparable lesion complexity. Women exhibited smaller femoral artery diameters, more side branches at the puncture area and higher bifurcations. In-hospital complications occurred more frequently in women compared to men (16.3% vs. 6.8%; = 0.044). Female sex independently predicted in-hospital complications (OR = 2.92; CI 1.07 to 7.60; = 0.024), yet lost significance after adjustment for femoral artery characteristics. Maximal femoral artery diameter (OR = 0.30, 95% CI: 0.17 to 0.50, < 0.001) and side-branch density (OR = 2.45, 95% CI: 1.26 to 5.20, = 0.012) independently predicted in-hospital complications. Female patients undergoing CTO PCI are at increased risk for procedural complications, likely driven by femoral artery anatomical differences. Detailed pre-procedural assessment of femoral artery metrics may improve patient selection, procedural planning, and outcomes, particularly among women.
经皮冠状动脉介入治疗（PCI）慢性完全闭塞病变（CTO）仍然是一个复杂的手术，需要术者具备先进的技术和专用设备。尽管在经验丰富的中心成功率有所提高，但CTO PCI的院内并发症仍然显著较高。据报道，接受CTO PCI的女性患者并发症发生率更高；然而，其潜在机制仍未得到充分明确。我们前瞻性地纳入了4年（2018 - 2021年）内在我们大学附属医院三级医疗中心接受CTO PCI的连续患者，旨在阐明院内并发症的性别差异。此外，我们研究了股动脉血管造影指标对院内并发症的影响。在271例行顺行或逆行CTO PCI的患者中，222例（81.9%）为男性，49例（18.9%）为女性。女性患者年龄显著更大（67±11岁对72±12岁；P = 0.005），且病变复杂程度相当。女性的股动脉直径较小，穿刺区域的侧支更多，分叉更高。与男性相比，女性院内并发症发生更频繁（16.3%对6.8%；P = 0.044）。女性性别独立预测院内并发症（OR = 2.92；CI 1.07至7.60；P = 0.024），但在调整股动脉特征后失去显著性。最大股动脉直径（OR = 0.30，95% CI：0.17至0.50，P < 0.001）和侧支密度（OR = 2.45，95% CI：1.26至5.20，P = 0.012）独立预测院内并发症。接受CTO PCI的女性患者手术并发症风险增加，可能是由股动脉解剖差异所致。术前对股动脉指标进行详细评估可能会改善患者选择、手术规划和预后，尤其是在女性患者中。
