Outcomes of Complex Percutaneous Cardiac Interventions in Women
Complex percutaneous cardiac intervention (PCI) is a growing procedure in modern day cath labs. The treated population is often older, with multiple comorbidities, complex coronary anatomy, left ventricular dysfunction, and possibly concomitant valvular heart disease and/or cardiogenic shock. As suc...
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| Format: | Article |
| Language: | English |
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Radcliffe Medical Media
2023-11-01
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| Series: | US Cardiology Review |
| Online Access: | https://www.uscjournal.com/articleindex/usc.2022.21 |
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| author | Mirvat Alasnag Valeria Paradies Nicola Ryan Sara C Martinez |
| author_facet | Mirvat Alasnag Valeria Paradies Nicola Ryan Sara C Martinez |
| author_sort | Mirvat Alasnag |
| collection | DOAJ |
| description | Complex percutaneous cardiac intervention (PCI) is a growing procedure in modern day cath labs. The treated population is often older, with multiple comorbidities, complex coronary anatomy, left ventricular dysfunction, and possibly concomitant valvular heart disease and/or cardiogenic shock. As such, PCI of bifurcations, chronic total occlusions, and atherectomy coronary interventions are becoming more common. The outcomes in terms of acute procedural success, procedure-related complications, and long-term mortality or heart failure hospitalizations are important to consider. Unfortunately, to date there is a paucity of data identifying sex and gender disparities following such interventions. With respect to bifurcation lesions, women usually have more comorbidities with less complex coronary anatomy. However, despite less complex anatomy, women have a significantly increased risk of MI. These differences are also noted with left main stem and multivessel disease, during which women appear to have a trend towards worse outcomes following PCI compared with coronary artery bypass grafting. Randomized trials have revealed that women present with increased cardiovascular risk factors, which may contribute to adverse longer-term outcomes. Revascularization of women with concomitant valvular heart disease is particularly challenging because the existing data are conflicted on not only the indication, but also the timing of revascularization. Similarly, women undergoing PCI of calcified lesions with drug-eluting stents have a worse clinical profile and remain at increased ischemic risk. The lower incidence of coronary calcification in women, combined with the under-representation of women in randomized trials, poses a real challenge when attempting to address safety and survival benefit in women undergoing complex interventions. This warrants dedicated trials exploring the safety and efficacy of complex interventions in women. |
| format | Article |
| id | doaj-art-37bb59df9c51476abbd023378d641cbf |
| institution | DOAJ |
| issn | 1758-3896 1758-390X |
| language | English |
| publishDate | 2023-11-01 |
| publisher | Radcliffe Medical Media |
| record_format | Article |
| series | US Cardiology Review |
| spelling | doaj-art-37bb59df9c51476abbd023378d641cbf2025-08-20T02:39:18ZengRadcliffe Medical MediaUS Cardiology Review1758-38961758-390X2023-11-011710.15420/usc.2022.21Outcomes of Complex Percutaneous Cardiac Interventions in WomenMirvat AlasnagValeria Paradies0Nicola Ryan1Sara C Martinez2Department of Cardiology, Maasstad Hospital, Rotterdam, the NetherlandsAberdeen Royal Infirmary, University of Aberdeen, Aberdeen, UKDivision of Cardiology, Providence St Peter Hospital, Olympia, WAComplex percutaneous cardiac intervention (PCI) is a growing procedure in modern day cath labs. The treated population is often older, with multiple comorbidities, complex coronary anatomy, left ventricular dysfunction, and possibly concomitant valvular heart disease and/or cardiogenic shock. As such, PCI of bifurcations, chronic total occlusions, and atherectomy coronary interventions are becoming more common. The outcomes in terms of acute procedural success, procedure-related complications, and long-term mortality or heart failure hospitalizations are important to consider. Unfortunately, to date there is a paucity of data identifying sex and gender disparities following such interventions. With respect to bifurcation lesions, women usually have more comorbidities with less complex coronary anatomy. However, despite less complex anatomy, women have a significantly increased risk of MI. These differences are also noted with left main stem and multivessel disease, during which women appear to have a trend towards worse outcomes following PCI compared with coronary artery bypass grafting. Randomized trials have revealed that women present with increased cardiovascular risk factors, which may contribute to adverse longer-term outcomes. Revascularization of women with concomitant valvular heart disease is particularly challenging because the existing data are conflicted on not only the indication, but also the timing of revascularization. Similarly, women undergoing PCI of calcified lesions with drug-eluting stents have a worse clinical profile and remain at increased ischemic risk. The lower incidence of coronary calcification in women, combined with the under-representation of women in randomized trials, poses a real challenge when attempting to address safety and survival benefit in women undergoing complex interventions. This warrants dedicated trials exploring the safety and efficacy of complex interventions in women.https://www.uscjournal.com/articleindex/usc.2022.21 |
| spellingShingle | Mirvat Alasnag Valeria Paradies Nicola Ryan Sara C Martinez Outcomes of Complex Percutaneous Cardiac Interventions in Women US Cardiology Review |
| title | Outcomes of Complex Percutaneous Cardiac Interventions in Women |
| title_full | Outcomes of Complex Percutaneous Cardiac Interventions in Women |
| title_fullStr | Outcomes of Complex Percutaneous Cardiac Interventions in Women |
| title_full_unstemmed | Outcomes of Complex Percutaneous Cardiac Interventions in Women |
| title_short | Outcomes of Complex Percutaneous Cardiac Interventions in Women |
| title_sort | outcomes of complex percutaneous cardiac interventions in women |
| url | https://www.uscjournal.com/articleindex/usc.2022.21 |
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