Sex Differences in the Short and Long-term Outcomes Following Rotational Atherectomy. A Meta-analysis

Background Rotational atherectomy (RA) is used to address complex calcified coronary lesions but data regarding the association between gender and outcomes of patients undergoing RA remained uncertain. We aimed to investigate the short and long-term outcomes of patients undergoing RA based on sex. Methods A systematic literature search was performed in PubMed, Embase and Cochrane databases from its inception until August 2023 for relevant studies. Endpoints were pooled using the DerSimonian and Laird random-effects model as odd ratio (OR) with 95% confidence intervals (CI). Results 7 studies with 8,490 patients (2,565 women and 5,925 men) undergoing RA were included in the study. In terms of periprocedural outcomes, women had a higher risk of in-hospital mortality (OR 2.00, 95% CI 1.08-3.68, p=0.03), coronary dissection (OR 1.80, 95% CI 1.05-3.10, p=0.03), coronary perforation (OR 1.96, 95% CI 1.19-3.23, p=0.01), and stroke (OR 4.22, 95% CI 1.06-16.82, p=0.04) compared to men. There were no significant differences between women and men in terms of MACE (OR 1.43, 95% CI 0.69-2.94, p=0.33), MI (OR 1.35, 95% CI 0.87-2.08, p=0.18), bleeding (OR 1.71, 95% CI 0.88-3.30, p=0.11), and cardiac tamponade (OR 2.30, 95% CI 0.45-11.68, p=0.32). Over a follow-up period of 3 years, results of meta-analysis showed that women had a higher risk of all-cause mortality (OR 1.45, 95% CI 1.19-1.77, p<0.001), long-term MACE (OR 1.38, 95% CI 1.10-1.74, p=0.01), and long-term stroke (OR 3.41, 95% CI 1.63-7.17, p<0.001). The risk of long-term MI was found to be similar between both gender (OR 1.45, 95% CI 0.95-2.22, p=0.09). Conclusion In conclusion, female gender is associated with adverse periprocedural and long-term outcome following RA. Women consistently demonstrated higher risk of in-hospital mortality, coronary dissection, coronary perforation, and stroke in the periprocedural period. Long-term follow-up further highlighted a heightened risk for women in terms of all-cause mortality and stroke.