Background: Rotational atherectomy (RA) is an established technique for managing severely calcified coronary artery disease (CAD) during percutaneous coronary intervention (PCI). However, to date the influence of gender on procedural and long-term outcomes remains unclear.
Methods: This retrospective cohort study analyzed 710 patients (533 males, 177 females) undergoing RA-assisted PCI for severely calcified CAD between January 2010 and December 2022. Patients who presented with ST-segment elevation myocardial infarction (STEMI), had chronic total occlusions (CTO), or those who had received bare-metal stents (BMS) were excluded. In-hospital adverse outcomes and one-year rates of major adverse cardiac events (MACE) were analysed. The In-hospital adverse outcomes endpoint was a composite of residual stenosis ≥ 30% at the end of the procedure, persistent slow flow, coronary dissection beyond the primary lesion, coronary perforation, burr entrapment, in-hospital death, periprocedural myocardial infarction, in-hospital revascularisation, or stroke. MACE was defined as a composite of cardiac death, spontaneous myocardial infarction (MI), or target vessel revascularization (TVR).
Results: Females were older (78.6 [73.5-83.0] vs 76.0 [70.4-80.7], p<0.001) with lower BMI (26.0 [23.9-29.8] vs 27.4 [25.0-30.0], p=0.009), and less frequent history of coronary artery bypass operation (12.4% vs 19.1%, p=0.042). No significant sex-based differences were found in left ventricular function, vessel complexity, or procedural variables. In-hospital adverse outcomes were more frequent in the female compared to male patients; however, this did not reach statistical significance (15.3% vs. 11.3%, adj. OR 1.53, 95% CI 0.92–2.53, p=0.099). Moreover, reduced LVEF <40% (adj. OR 2.0, 95% CI 1.13–3.54, p=0.017), bifurcation lesions (adj. OR 1.85, 95% CI 1.16–2.96, p=0.010), and moderate to severe target vessel tortuosity (adj. OR 1.90, 95% CI 1.19–3.03, p=0.007) emerged as independent predictors of in-hospital adverse outcomes. On the contrary, use of intravascular imaging was protective against in-hospital adverse outcomes (adj. OR 0.54, 95% CI 0.31–0.95, p=0.030). After one-year follow-up, MACE rates were comparable between both female and male patients (12% vs. 13%, adj. HR 0.95, 95% CI 0.55–1.63, p=0.848). Total stent length ≥60 mm was independently associated with one-year MACE (adj. HR 2.00, 95% CI 1.28–3.12, p=0.002).
Conclusion: In this cohort, no significant gender-related differences were observed in procedural or long-term outcomes following RA-assisted PCI. In this cohort, outcome was primarily influenced by anatomical complexity and left ventricular dysfunction.
