Impact of sex on myocardial perfusion following percutaneous coronary intervention of chronic total coronary occlusions.

Objectives: We sought to investigate the impact of sex on myocardial perfusion changes following chronic total coronary occlusion (CTO) percutaneous coronary intervention (PCI) as measured by [O]HO positron-emission tomography (PET) perfusion imaging.

Background: CTO PCI has been associated with an increase in myocardial perfusion, yet females are less likely to undergo revascularization. As such, data on the impact of sex on myocardial perfusion following CTO PCI is scarce.

Methods: A total of 212 patients were prospectively enrolled and underwent CTO PCI combined with [O]HO PET perfusion imaging prior to and 3 months after PCI. Hyperemic myocardial blood flow (hMBF, mL·min·g) and coronary flow reserve (CFR) allocated to the CTO territory were quantitatively assessed.

Results: This study comprised 34 (16 %) females and 178 (84 %) males. HMBF at baseline did not differ between sexes. Females showed a higher increase in hMBF than males (Δ1.34 ± 0.67 vs. Δ1.06 ± 0.74, p = 0.044), whereas post-PCI hMBF was comparable (2.59 ± 0.85 in females vs. 2.28 ± 0.84 in males, p = 0.052). Female sex was independently associated with a higher increase in hMBF after correction for clinical covariates. CFR increase after revascularization was similar in females and males (Δ1.47 ± 0.99 vs. Δ1.30 ± 1.14, p = 0.711).

Conclusions: The present study demonstrates a greater recovery of stress perfusion in females compared to males as measured by serial [O]HO PET imaging. In addition, a comparable increase in CFR was found in females and males. These results emphasize the benefit of performing CTO PCI in both sexes.

Clinical Perspective: What is new? What are the clinical implications?