Sex Differences In Post-Procedural Complications Of Patients Undergoing Coronary Atherectomy: A Systematic Review And Meta-Analysis
Presenter
Shiva Ponamgi, MBBS, CHI Health Creighton University Medical Center, Omaha, NE
Shiva Ponamgi, MBBS1, Arslan Ahmed, MD2, Venkata Siva Kumar Pajjuru, MD1, Abhishek Thandra, MD1, Aravdeep Jhand, MBBS3, Gauravpal Singh Gill1, Raahat Bansal, MD4, Himanshu Agarwal, MD5 and Arun Kanmanthareddy, M.D., FSCAI4, (1)CHI Health Creighton University Medical Center, Omaha, NE, (2)Creighton University School of Medicine, Omaha, Nebraska, (3)University Nebraska Medical Center, Omaha, NE, (4)Creighton University School of Medicine, Omaha, NE, (5)-, Omaha, NE
Keywords: Atherectomy, Complex and High-risk Coronary Intervention (CHIP), Complications and Coronary
Background
Coronary atherectomy (CA) is commonly utilized to treat complex calcified coronary lesions but earlier studies are conflicted on the rates of post-procedural complications and clinical outcomes amongst men versus women.
We conducted a meta-analysis to further evaluate these studies.
Methods
PubMed, Google scholar and Cochrane databases were searched for all studies comparing sex differences in procedural and clinical outcomes following CA. The primary outcomes of interest were all-cause mortality, myocardial infarction (MI) and stroke. The secondary outcomes were post-procedural coronary dissection (CD), coronary perforation (CP), cardiac tamponade (CT), slow or no flow in target vessel and bleeding. Pooled risk ratios (RR) with their corresponding 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel random-effects model.
Results
Five observational studies with 2,729 patients (men: 1850, women: 879) were included in the meta-analysis. There was no significant difference in risk of all-cause mortality or MI (p >0.05) between the groups. However, women had increased risk of stroke (RR 3.98, 95% CI 1.06 – 14.90, p=0.04). Risk of procedure related CD (RR 2.10, 95% CI 1.23 – 3.58, p=0.006), CT (RR 3.55, 95% CI 1.23 – 10.25, p=0.02) and bleeding (RR 2.29, 95% CI 1.24 – 4.23, p=0.008) was also higher in women while the rates of CP and risk of slow or no flow in the revascularized artery were not different between the groups [Figure 1].
Conclusions
Our analysis suggests, although overall mortality and risk of MI after CA maybe similar in men and women, women may be at a significantly higher risk of post-procedural stroke, bleeding, CD and CT.
