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Women were older (mean 76\u2009years vs. 72\u2009years; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and had more urgent procedures (64.6 vs. 47.3%; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). Females received fewer radial procedures (75.1 vs. 85.1%; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and less intravascular imaging guidance (16.8 vs. 25.0%; <jats:italic>p<\/jats:italic> = .008). After propensity score adjustment, the primary endpoint of net adverse cardiac events (net adverse clinical events: all\u2010cause death, myocardial infarction, stroke, target vessel revascularization plus any procedural complication<jats:bold>)<\/jats:bold> occurred more often in female patients (15.1 vs. 9.0%; adjusted OR 1.81 95% CI 1.04\u20133.13; <jats:italic>p<\/jats:italic> = .037). This was driven by an increased risk of procedural complications rather than procedural major adverse cardiac events (MACE). Specifically, women were more likely to experience coronary dissection (4.6 vs. 1.3%; <jats:italic>p<\/jats:italic> = .008), cardiac tamponade (2.1 vs. 0.4%; <jats:italic>p<\/jats:italic> = .046) and significant bleeding (BARC \u22652: 5.3 vs. 2.3). Despite this, overall MACE\u2010free survival was similar between males and females (adjusted HR 1.03; 95% CI 0.80\u20131.34; <jats:italic>p<\/jats:italic> = .81). Procedural complications during RA were associated with almost double the incidence of MACE at long\u2010term follow\u2010up (HR 1.92; 95% CI 1.34\u20132.77; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Women may be at greater risk of procedural complications following rotational atherectomy. These include periprocedural bleeding episodes and coronary perforation leading to cardiac tamponade. Despite this, the adjusted overall long\u2010term survival free of major adverse cardiac events was similar between males and females.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.28373","type":"journal-article","created":{"date-parts":[[2019,7,2]],"date-time":"2019-07-02T06:05:31Z","timestamp":1562047531000},"page":"232-241","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Sex differences in procedural and clinical outcomes following rotational atherectomy"],"prefix":"10.1002","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4009-6652","authenticated-orcid":false,"given":"Thomas J.","family":"Ford","sequence":"first","affiliation":[{"name":"West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital  Clydebank UK"},{"name":"British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences University of Glasgow  Glasgow 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Institute of Cardiovascular and Medical Sciences University of Glasgow  Glasgow Scotland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Rocchiccioli","sequence":"additional","affiliation":[{"name":"West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital  Clydebank UK"},{"name":"British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences University of Glasgow  Glasgow Scotland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Good","sequence":"additional","affiliation":[{"name":"West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital  Clydebank UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hany","family":"Eteiba","sequence":"additional","affiliation":[{"name":"West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital  Clydebank 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