Skip to main content
SpringerLink
Log in

Sex-Based Differences in Chronic Total Occlusion Management

  • Women and Ischemic Heart Disease (A. Maran, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

ᅟ

Chronic total occlusions (CTOs) are an important and increasingly recognized subgroup of coronary lesions, documented in at least 30%, but up to 52% of patients with coronary artery disease (CAD) undergoing coronary angiography. Percutaneous coronary intervention (PCI) of these lesions is increasingly pursued, with excellent success rates.

Purpose of Review

It is known that gender differences exist in the presentation of CAD, as well as in clinical outcomes after routine PCI; however, it is not well described how these differences pertain to management of CTOs. This review summarizes the available data regarding sex-based differences in CTO management and outcomes.

Recent Findings

Women comprise approximately 20% of CTO registry and trial participants.

Summary

As has been demonstrated in PCI studies, women comprise a minority of patients in CTO PCI registries and trials. Sex-based differences exist in complication rates, collateral formation, and outcomes and need further evaluation in future studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kearney K, Hira RS, Riley RF, Kalyanasundaram A, Lombardi WL. Update on the management of chronic total occlusions in coronary artery disease. Curr Atheroscler Rep. 2017;19(4):19. https://doi.org/10.1007/s11883-017-0655-0.

    Article  PubMed  Google Scholar 

  2. Brilakis ES, Banerjee S, Karmpaliotis D, Lombardi WL, Tsai TT, Shunk KA, et al. Procedural outcomes of chronic total occlusion percutaneous coronary intervention. J Am Coll Cardiol Intv. 2015;8(2):245–53. https://doi.org/10.1016/j.jcin.2014.08.014.

    Article  Google Scholar 

  3. Garcia S, Abdullah S, Banerjee S, Brilakis ES. Chronic total occlusions: patient selection and overview of advanced techniques. Curr Cardiol Rep. 2013;15(2):334. https://doi.org/10.1007/s11886-012-0334-2.

    Article  PubMed  Google Scholar 

  4. Peltonen M, Lundberg V, Huhtasaari F, Asplund K. Marked improvement in survival after acute myocardial infarction in middle-aged men but not in women. The Northern Sweden MONICA study 1985-94. J Intern Med. 2000;247(5):579–87.

    Article  CAS  Google Scholar 

  5. Kahn JK. Angiographic suitability for catheter revascularization of total coronary occlusions in patients from a community hospital setting. Am Heart J. 1993;126(3 Pt 1):561–4.

    Article  CAS  Google Scholar 

  6. Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Osherov AB, Yalonetsky S, et al. Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol. 2012;59(11):991–7. https://doi.org/10.1016/j.jacc.2011.12.007.

    Article  PubMed  Google Scholar 

  7. Wolff R, Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Sparkes JD, et al. Gender differences in the prevalence and treatment of coronary chronic total occlusions. Catheter Cardiovasc Interv. 2015;87(6):1063–70. https://doi.org/10.1002/ccd.26330.

    Article  PubMed  Google Scholar 

  8. Grantham JA, Jones PG, Cannon L, Spertus JA. Quantifying the early health status benefits of successful chronic total occlusion recanalization: results from the FlowCardia’s Approach to Chronic Total Occlusion Recanalization (FACTOR) trial. Circ Cardiovasc Qual Outcomes. 2010;3(3):284–90. https://doi.org/10.1161/CIRCOUTCOMES.108.825760.

    Article  PubMed  Google Scholar 

  9. Colombo A, Mikhail GW, Michev I, et al. Treating chronic total occlusions using subintimal tracking and reentry: the STAR technique. Catheter Cardiovasc Interv. 2005;64(4):407–11 discussion412. https://doi.org/10.1002/ccd.20307.

    Article  PubMed  Google Scholar 

  10. Brilakis ES, Grantham JA, Rinfret S, Wyman RM, Burke MN, Karmpaliotis D, et al. A percutaneous treatment algorithm for crossing coronary chronic total occlusions. J Am Coll Cardiol Intv. 2012;5(4):367–79. https://doi.org/10.1016/j.jcin.2012.02.006.

    Article  Google Scholar 

  11. Christopoulos G, Menon RV, Karmpaliotis D, Alaswad K, Lombardi W, Grantham A, et al. The efficacy and safety of the “hybrid” approach to coronary chronic total occlusions: insights from a contemporary multicenter US registry and comparison with prior studies. J Invasive Cardiol. 2014;26(9):427–32.

    PubMed  PubMed Central  Google Scholar 

  12. Xu J, Murphy SL, Kochanek KD, Arias E. Mortality in the United States, 2015. NCHS Data Brief. 2016;267:1–8.

    Google Scholar 

  13. Daly C, Clemens F, Lopez Sendon JL, Tavazzi L, Boersma E, Danchin N, et al. Gender differences in the management and clinical outcome of stable angina. Circulation. 2006;113(4):490–8. https://doi.org/10.1161/CIRCULATIONAHA.105.561647.

    Article  PubMed  Google Scholar 

  14. Shaw LJ, Shaw RE, Merz CNB, Brindis RG, Klein LW, Nallamothu B, et al. Impact of ethnicity and gender differences on angiographic coronary artery disease prevalence and in-hospital mortality in the American College of Cardiology-National Cardiovascular Data Registry. Circulation. 2008;117(14):1787–801. https://doi.org/10.1161/CIRCULATIONAHA.107.726562.

    Article  PubMed  Google Scholar 

  15. Shaw LJ, Bairey Merz CN, Pepine CJ, Reis SE, Bittner V, Kelsey SF, et al. Insights from the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) study: part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies. J Am Coll Cardiol. 2006;47(3 Suppl):S4–S20. https://doi.org/10.1016/j.jacc.2005.01.072.

    Article  PubMed  Google Scholar 

  16. Bairey Merz CN, Shaw LJ, Reis SE, Bittner V, Kelsey SF, Olson M, et al. Insights from the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) study: part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J Am Coll Cardiol. 2006;47(3 Suppl):S21–9. https://doi.org/10.1016/j.jacc.2004.12.084.

    Article  PubMed  Google Scholar 

  17. Wenger NK. Clinical presentation of CAD and myocardial ischemia in women. J Nucl Cardiol. 2016;23(5):976–85. https://doi.org/10.1007/s12350-016-0593-1.

    Article  PubMed  Google Scholar 

  18. Bataille Y, Déry J-P, Larose É, Abdelaal E, Machaalany J, Rodés-Cabau J, et al. Incidence and clinical impact of concurrent chronic total occlusion according to gender in ST-elevation myocardial infarction. Catheter Cardiovasc Interv. 2013;82(1):19–26. https://doi.org/10.1002/ccd.24697.

    Article  PubMed  Google Scholar 

  19. Claessen BE, Chieffo A, Dangas GD, Godino C, Lee SW, Obunai K, et al. Gender differences in long-term clinical outcomes after percutaneous coronary intervention of chronic total occlusions. J Invasive Cardiol. 2012;24(10):484–8.

    PubMed  Google Scholar 

  20. Melloni C, Berger JS, Wang TY, Gunes F, Stebbins A, Pieper KS, et al. Representation of women in randomized clinical trials of cardiovascular disease prevention. Circ Cardiovasc Qual Outcomes. 2010;3(2):135–42. https://doi.org/10.1161/CIRCOUTCOMES.110.868307.

    Article  PubMed  Google Scholar 

  21. Sapontis J, Marso SP, Cohen DJ, Lombardi W, Karmpaliotis D, Moses J, et al. The Outcomes, Patient Health Status, and Efficiency IN Chronic Total Occlusion Hybrid Procedures registry: rationale and design. Coron Artery Dis. 2017;28(2):110–9. https://doi.org/10.1097/MCA.0000000000000439.

    Article  PubMed  Google Scholar 

  22. Salisbury AC, Sapontis J, Saxon JT, Gosch KL, Lombardi WL, Karmpaliotis D, et al. Association of stress test risk classification with health status after chronic total occlusion angioplasty (from the Outcomes, Patient Health Status and Efficiency in Chronic Total Occlusion Hybrid Procedures [OPEN-CTO] Study). Am J Cardiol. 2018;121(5):558–63. https://doi.org/10.1016/j.amjcard.2017.11.024.

    Article  PubMed  Google Scholar 

  23. Henriques JPS, Hoebers LP, Råmunddal T, Laanmets P, Eriksen E, Bax M, et al. Percutaneous intervention for concurrent chronic total occlusions in patients with STEMI: the EXPLORE trial. J Am Coll Cardiol. 2016;68(15):1622–32. https://doi.org/10.1016/j.jacc.2016.07.744.

    Article  PubMed  Google Scholar 

  24. Yetkin E, Topal E, Erguzel N, Senen K, Heper G, Waltenberger J. Diabetes mellitus and female gender are the strongest predictors of poor collateral vessel development in patients with severe coronary artery stenosis. Angiogenesis. 2015;18(2):201–7. https://doi.org/10.1007/s10456-015-9460-y.

    Article  CAS  PubMed  Google Scholar 

  25. Sharma V, Wilson W, Smith W, McEntegart M, Oldroyd K, Sidik N, et al. Comparison of characteristics and complications in men versus women undergoing chronic total occlusion percutaneous intervention. Am J Cardiol. 2017;119(4):535–41. https://doi.org/10.1016/j.amjcard.2016.11.004.

    Article  PubMed  Google Scholar 

  26. Stähli BE, Gebhard C, Gick M, Ferenc M, Mashayekhi K, Buettner HJ, et al. Comparison of outcomes in men versus women after percutaneous coronary intervention for chronic total occlusion. Am J Cardiol. 2017;119(12):1931–6. https://doi.org/10.1016/j.amjcard.2017.03.021.

    Article  PubMed  Google Scholar 

  27. Fasseas P, Orford JL, Panetta CJ, Bell MR, Denktas AE, Lennon RJ, et al. Incidence, correlates, management, and clinical outcome of coronary perforation: analysis of 16,298 procedures. Am Heart J. 2004;147(1):140–5.

    Article  Google Scholar 

  28. Dodge JT, Brown BG, Bolson EL, Dodge HT. Lumen diameter of normal human coronary arteries. Influence of age, sex, anatomic variation, and left ventricular hypertrophy or dilation. Circulation. 1992;86(1):232–46.

    Article  Google Scholar 

  29. Rao SV, Hess CN, Barham B, Aberle LH, Anstrom KJ, Patel TB, et al. A registry-based randomized trial comparing radial and femoral approaches in women undergoing percutaneous coronary intervention: the SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women) trial. J Am Coll Cardiol Intv. 2014;7(8):857–67. https://doi.org/10.1016/j.jcin.2014.04.007.

    Article  Google Scholar 

  30. Feldman DN, Swaminathan RV, Kaltenbach LA, Baklanov DV, Kim LK, Wong SC, et al. Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention: an updated report from the national cardiovascular data registry (2007-2012). Circulation. 2013;127(23):2295–306. https://doi.org/10.1161/CIRCULATIONAHA.112.000536.

    Article  PubMed  Google Scholar 

  31. Ayanian JZ, Epstein AM. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med. 1991;325(4):221–5. https://doi.org/10.1056/NEJM199107253250401.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, University of Washington, Seattle, WA, USA

    Amy Cheney, Kathleen E. Kearney & William Lombardi

Authors
  1. Amy Cheney
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kathleen E. Kearney
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William Lombardi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amy Cheney.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Tis article is part of the Topical Collection on Women and Ischemic Heart Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cheney, A., Kearney, K.E. & Lombardi, W. Sex-Based Differences in Chronic Total Occlusion Management. Curr Atheroscler Rep 20, 60 (2018). https://doi.org/10.1007/s11883-018-0760-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11883-018-0760-8

Keywords

Search

Navigation