LAUSR

Large registries and a recent meta ‐ analysis of randomized trials showed that women have worse outcome after myocardial revascularization both with coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI). 1,2 In this issue of Catheterization & Cardiovascular Interventions, Kostantinis and coworkers suggest that recanalization of chronic total occlusions (CTO) represents an exception to this general rule in terms of efficacy but confirm a significantly higher incidence of major adverse events such as vascular damage and pericardial tamponade (but not death). The presence of at least one CTO is documented in 18% – 30% of patients undergoing coronary angiography, without differences between sexes. Women, however, are less likely to be referred for coronary angiography with a frightening delay also in acute coronary syndromes. Cardiovascular disease (CVD) is the first cause of death for both men and women but women more often present with atypical symptoms, more frequently overlooked or misinterpreted. In patients with CTO the chief complaint is dyspnea more often than angina and the bias against studying female patients without typical angina is stronger. This may explain the very low percentage of female patients in whom CTO recanalization is attempted in the large contemporary Prospective Global Registry for the Study of Chronic Total Occlusion Intervention PROGRESS ‐ CTO registry (only 19% of the 9457 CTO lesions included). This is particularly deplorable if