Clinical impact of sex on carotid revascularization.

Abstract

BACKGROUND:

The impact of sex in the management of carotid disease is unclear in the current literature. Therefore, we evaluated the effect of sex on perioperative outcomes following carotid endarterectomy (CEA) and carotid artery stenting (CAS).

METHODS:

We included patients who underwent CEA or CAS between 2012 and 2017 in the Vascular Quality Initiative database. Our primary outcome was perioperative stroke/death. Secondary outcomes were in-hospital stroke, 30-day mortality, and in-hospital MI. We compared perioperative outcomes between female and male patients, stratified by treatment modality and symptom status, and used multivariable regression to account for differences in baseline characteristics.

RESULTS:

A total of 83,436 patients underwent either a CEA (71,383) or CAS (12,053). Asymptomatic and symptomatic CEA females were less likely to be on a preoperative antiplatelet agent, when compared to males. Females overall, were less likely to be on a preoperative statin and more likely to have chronic obstructive pulmonary disease. Within the CAS cohort, females were more likely to have a previous ipsilateral CEA. There were no differences between males and females in major adverse events following CEA for asymptomatic disease. Following CEA for symptomatic disease, there was no difference in stroke/death rate or in-hospital stroke. However, females experienced a higher 30-mortality after adjustment (univariate: 1.0% vs 0.7%, P = .04; adjusted: odds ratio [OR], 1.4:1.02-1.94). Following CAS for asymptomatic disease, females experienced a higher rate of perioperative stroke/death (2.9% vs 1.9% P = .02; OR, 1.5: 1.05-2.03) and in-hospital stroke (2.1% vs 1.2% P = .01; OR, 1.8: 1.20-2.60). There were no differences in outcomes for symptomatic females vs males undergoing CAS.

CONCLUSIONS:

Females with carotid disease less frequently receive optimal medical treatment with antiplatelet agents and statins. This is an important target area for quality improvement issue in both females and males. Furthermore, among symptomatic CEA patients the female sex is associated with higher mortality and among asymptomatic CAS patients, females experience higher rates of stroke/death. These findings suggest that careful patient selection is necessary in the treatment of female patients. Quality improvement projects should be created to further investigate and eliminate the disparities of optimal medical management between the sexes.

• Authors: Kirsten D Dansey, Alexander B Pothof, Sara L Zettervall, Nicholas J Swerdlow, Patric Liang, Joseph R Schneider, Brian W Nolan, Marc L Schermerhorn
• Journal: Journal of vascular surgery (J Vasc Surg) Vol. 71 Issue 5 Pg. 1587-1594.e2 (05 2020) ISSN: 1097-6809 [Electronic] United States
• PMID: 32014286 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Chemical References

• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Platelet Aggregation Inhibitors

Topics

• Aged
• Aged, 80 and over
• Carotid Artery Diseases (complications, diagnostic imaging, mortality, therapy)
• Databases, Factual
• Endarterectomy, Carotid (adverse effects, mortality)
• Endovascular Procedures (adverse effects, instrumentation, mortality)
• Female
• Health Status Disparities
• Healthcare Disparities
• Hospital Mortality
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Male
• Myocardial Infarction (mortality)
• Platelet Aggregation Inhibitors (therapeutic use)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Sex Factors
• Stents
• Stroke (mortality)
• Time Factors
• Treatment Outcome