title: Gender differences in long-term clinical outcomes after percutaneous coronary intervention of chronic total occlusions.
abstract: BACKGROUND
  Little is known about gender differences among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).
  
  
  METHODS
  A total of 1791 patients with 1852 CTOs underwent PCI at 3 centers in the United States, Italy, and South Korea between 1998 and 2007. We compared baseline characteristics, procedural success rates (residual stenosis <50%), and 5-year clinical event rates in male and female patients.
  
  
  RESULTS
  A total of 1534 men (86%) and 248 women (14%) were treated. After multivariate adjustment, procedural success rates were similar in men and women. The median follow-up duration was 2.9 years (interquartile range, 1.5-4.6 years). Successful CTO PCI was associated with reduced mortality (5.7% vs 9.2%; P<.01) and a reduced need for coronary artery bypass graft (CABG) surgery (3.1% vs 14.1%; P<.01) in male patients. In female patients, there was a trend toward a lower need for CABG after successful CTO PCI (4.0% vs 6.9%; P=.09). Rates of major adverse cardiac events (MACE; death, myocardial infarction, and CABG) were lower after successful PCI in both men and women (men, 13.1% vs 24.4% and P<.01; women, 12.3% vs 15.5% and P=.04). There was a significant interaction between gender and procedural success in terms of MACE (P<.01), indicating men had a greater reduction in MACE rate after successful CTO PCI compared with women.
  
  
  CONCLUSIONS
  Our study suggested a greater benefit of a successful CTO intervention in men compared with women. A minority of patients (14%) were women. CTO PCI in women is safe and feasible and should probably be considered more often. A randomized controlled trial is needed to accurately investigate the impact of CTO PCI in both men and women.
authors.affiliation: Cardiovascular Institute, Mount Sinai Medical Center, One Gustav L Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: Bimmer E
authors.initials: BE
authors.lastname: Claessen
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.forename: Cosmo
authors.initials: C
authors.lastname: Godino
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Kotaro
authors.initials: K
authors.lastname: Obunai
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Vaso
authors.initials: V
authors.lastname: Chantziara
authors.forename: Irini
authors.initials: I
authors.lastname: Apostolidou
authors.forename: José P S
authors.initials: JP
authors.lastname: Henriques
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D054059:Coronary Occlusion / Q000401:mortality* / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D015995:Prevalence; D056910:Republic of Korea; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States