Data regarding the potential influence of sex on outcomes of rotational atherectomy (RA) percutaneous coronary intervention (PCI) are scarce and conflicting. Using the Euro4C registry, an international prospective multicentric registry of RA PCI, we evaluated the influence of sex on clinical outcomes of RA PCI. Between October 2016 and July 2018, 966 patients were included. Among them, 267 (27.6%) were females. Female patients were older than males (77.7 yo +/- 9.8 vs 73.3 +/- 9.5 yo respectively, p<0.001) had a poorer renal function (43,1% of females had a GFR < 60 ml/min:1.73m² vs 30.4% of males, p<0.001) and were more frequently admitted for an acute coronary syndrome (32.2% vs 22.3% p=0.002). During RA procedure, women were less likely to be treated by radial approach (65.0% vs 74.4%, p=0.004). In-hospital major adverse cardiac event (MACE) rate – defined as cardiovascular death, myocardial infarction, stroke/transient ischemic attack, target lesion revascularization and coronary artery bypass grafting surgery – was higher in the female group (7.1% vs 3.7%, p=0.043). However, coronary perforation, dissection, slow/low flow and tamponade did not significantly differ among sex, neither did cardiovascular medications at discharge. At one year follow-up, rate of MACE was 18.4% in the female group vs 11.2% in the male group (adjusted HR 1.82 [1.24 -2.67], p=0.002). No significant bleeding differences were observed among sex, neither in hospital, nor during follow-up. In conclusion women had worse clinical outcomes following RA PCI during hospitalization and at one year follow-up than did men.
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