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Older Age, Not Sex, Predicts Lower Percutaneous Coronary Intervention Success

Key findings

  • Women account for a small proportion of patients who undergo chronic total occlusion percutaneous coronary intervention (CTO-PCI)
  • Sex is not an independent predictor of CTO-PCI technical success or in-hospital adverse events
  • Older age independently predicts lower CTO-PCI technical success and higher in-hospital adverse events

Although female sex and increasing age have been associated with worse outcomes after percutaneous coronary intervention (PCI), a recent study found only age to be associated with a higher rate of in-hospital complications and lower technical success after chronic total occlusion (CTO)-PCI.

Researchers, including Massachusetts General Hospital’s Director of Coronary Intervention, Farouc A. Jaffer, MD, PhD, analyzed outcomes of 1,644 patients who had CTO-PCIs performed between the years of 2012 to 2016 at 15 medical centers in the U.S. The results were published in the Journal of Invasive Cardiology. The mean patient age of the study was 65 years, and 86% were men. Women were older, with a mean age of 67 years, compared with a mean age of 65 years for men.

While 62 of patients presented with stable angina, women were more likely to present with acute coronary syndromes—32% of women versus 24% of men. Otherwise, women had similar baseline characteristics as men.

Among all patients, the technical success rate of CTO-PCIs was 88%, and the procedural success rate was 87%. Women experienced a higher technical success rate of 92% versus 87% for men and a similar procedural success rate of 89% versus 86%.

Overall, only 2.7% of patients experienced an in-hospital major adverse cardiac event (MACE), with increasing age as an independent predictor of MACE. The overall incidence of in-hospital MACE was similar between men and women, although women underwent emergency pericardiocentesis more often than men—2.1% in men versus 0.6% (P=0.04).

The researchers found in multivariable analysis that an age greater than 75 years independently predicted technical failure of CTO-PCI.

The most common target vessel for CTO-PCI was found to be the right coronary artery at 55%, the left anterior descending artery at 24% and the circumflex artery at 21%.

Researchers found older age to be associated with a greater number of comorbidities, including hypertension, dyslipidemia, stroke and chronic lung disease. Older patients experienced more moderate to severe calcification, although women had less moderate-to-severe tortuosity (28%) compared with men at (37%).

75%
 years of age independently predicts lower CTO-PCI technical success and higher in-hospital adverse events

92%
 of women experienced technical success from CTO-PCI

87%
 of men experienced technical success from CTO-PCI

Refer a patient to the Mass General's Corrigan Minehan Heart Center.

Learn more about Mass General’s CTO PCI Program

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