Sex-specific Inequalities in the Treatment of Severely Calcified Coronary Lesions: A Sub-analysis of the PREPARE-CALC Trial

Author:

Fitzgerald Sean1ORCID,Gimenez Maria Rubini2ORCID,Allali Abdelhakim3ORCID,Toelg Ralph3,Sulimov Dmitriy S2ORCID,Geist Volker3ORCID,Kastrati Adnan4ORCID,Thiele Holger2ORCID,Richardt Gert3,Abdel-Wahab Mohamed2

Affiliation:

1. Heart Center Leipzig, Leipzig, Germany; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland

2. Heart Center Leipzig, Leipzig, Germany

3. Heart Center, Segeberger Kliniken, Bad Segeberg, Germany

4. Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany

Abstract

Background: Coronary vessels in women may have anatomical and histological particularities. The aim of this study was to investigate sex-specific characteristics and outcomes of patients with calcified coronary arteries in the Prepare-CALC (Comparison of Strategies to Prepare Severely Calcified Coronary Lesions) trial. Methods: The Prepare-CALC trial randomised patients with severe coronary calcification to coronary lesion preparation either using modified balloons (MB; cutting or scoring) or rotational atherectomy (RA). Results: Of 200 randomised patients, 24% were women. Strategy success in general was similar between women (93.8%) and men (88.2%; p=0.27). For men, strategy success was significantly more common with an RA-based strategy than an MB-based strategy (98.7% in the RA group versus 77.3% in the MB group, p<0.001), whereas for women there was no evidence of a significant difference in strategy success between RA and MB (95.7% in the RA group versus 92% in the MB group, p>0.99, p for interaction between sex and treatment strategy=0.03). Overall, significant complications such as death, MI, stent thrombosis, bypass operation and perforations were rare and did not differ significantly by gender or treatment strategy. Plaque rupture and disrupted calcified nodules were more common in women. Conclusion: In a well-defined patient population with severely calcified coronary arteries, lesion preparation with an RA strategy was superior to an MB strategy in men. For women, both RA and MB strategies appear to have a similar success rate, although definitive conclusions are limited due to the small number of women in the trial.

Publisher

Radcliffe Media Media Ltd

Subject

Cardiology and Cardiovascular Medicine

Reference31 articles.

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