The Impact of Gender on In-hospital Outcomes after Carotid Endarterectomy or Stenting

被引：35

作者：

Bisdas, T. ^{[1
,2
,3
]}

Egorova, N. ^{[4
]}

Moskowitz, A. J. ^{[4
]}

Sosunov, E. A. ^{[5
]}

Marin, M. L. ^{[1
]}

Faries, P. L. ^{[1
]}

Vouyouka, A. G. ^{[1
]}

机构：

[1] Mt Sinai Sch Med, Div Vasc Surg, Dept Surg, New York, NY 10029 USA

[2] Muenster Univ, Clin Vasc & Endovasc Surg, Munster, Germany

[3] St Franziskus Hosp, Munster, Germany

[4] Mt Sinai Sch Med, Dept Hlth Evidence & Policy, New York, NY 10029 USA

[5] Columbia Univ, Dept Pharmacol, New York, NY USA

来源：

EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY | 2012年 / 44卷 / 03期

关键词：

Carotid interventions; Gender; Sex; Males; Females; Stroke; SEX; ANGIOPLASTY; PREVENTION; PLAQUE; RISK;

D O I：

10.1016/j.ejvs.2012.06.009

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Aim: We sought to better define the impact of sex on 'in-hospital outcomes' after carotid endarterectomy (CEA) or stenting (CAS). Methods: Hospital discharge databases for all carotid interventions obtained from the New York State (NYS) Department of Health, Statewide Planning and Research Cooperative System between 2000 and 2009 (29,917 women, 39,771 men) were analysed. Mortality, stroke and composite event (stroke/death) were compared between procedures after matching of patients by propensity score. Acute myocardial infarction (AMI) was our secondary 'end' point. Results: More than 90% of patients in both sexes were asymptomatic (27,439 women and 36,295 men). Compared to men, asymptomatic women experienced more strokes after CEA (women: 1.38%, men: 1.16%, P = 0.03) and higher AMI rates after both procedures (CEA; women: 0.75%, men: 0.51%, P = 0.0009, CAS; women: 0.96%, men: 0.28%, P = 0.01). Between procedures, symptomatic women undergoing CAS showed higher rates of mortality (CAS: 4.19%, CEA: 0.47%, P = 0.01) and combined (stroke/mortality) events (CAS: 12.09%, CEA: 6.05%, P = 0.02). In all other cohorts, no statistically significant difference was found between the procedures. Conclusions: Compared to CEA. CAS led to inferior in-hospital outcomes only in symptomatic women in the last decade in NYS. Men and asymptomatic women showed comparable outcomes after both procedures, whereas asymptomatic females were more prone to AMI after both interventions. These sex-associated differences should be taken into account for the treatment of carotid artery disease. (C) 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

引用

页码：244 / 250

页数：7

共 29 条

[1]

[Anonymous], 2001, P 26 ANN SAS US GROU

[2]

Bedinghaus J, 2001, AM FAM PHYSICIAN, V63, P1393

[3] Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data [J].

Bonati, Leo H. ;

Dobson, Joanna ;

Algra, Ale ;

Branchereau, Alain ;

Chatellier, Gilles ;

Fraedrich, Gustav ;

Mali, Willem P. ;

Zeumer, Hermann ;

Brown, Martin M. ;

Mas, Jean-Louis ;

Ringleb, Peter A. .

LANCET, 2010, 376 (9746) :1062-1073

[4] Gender differences in blood velocities across carotid stenoses [J].

Comerota, AJ ;

Salles-Cunha, SX ;

Daoud, Y ;

Jones, L ;

Beebe, HG .

JOURNAL OF VASCULAR SURGERY, 2004, 40 (05) :939-944

[5] Mechanisms of gender-related outcome differences after carotid endarterectomy [J].

den Hartog, Anne G. ;

Algra, Ale ;

Moll, Frans L. ;

de Borst, Gert J. .

JOURNAL OF VASCULAR SURGERY, 2010, 52 (04) :1062-1071

[6] Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial (vol 7, pg 893, 2008) [J].

Eckstein, H-H ;

Ringleb, P. ;

Allenberg, J-R .

LANCET NEUROLOGY, 2009, 8 (02) :135-135

[7] Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial [J].

Ederle, Joerg ;

Dobson, Joanna ;

Featherstone, Roland L. ;

Bonati, Leo H. ;

van der Worp, H. Bart ;

de Borst, Gert J. ;

Lo, T. Hauw ;

Gaines, Peter ;

Dorman, Paul J. ;

Macdonald, Sumaira ;

Lyrer, Philippe A. ;

Hendriks, Johanna M. ;

McCollum, Charles ;

Nederkoorn, Paul J. ;

Brown, Martin M. ;

Algra, A. ;

Bamford, J. ;

Beard, J. ;

Bland, M. ;

Bradbury, A. W. ;

Brown, M. M. ;

Clifton, A. ;

Gaines, P. ;

Hacke, W. ;

Halliday, A. ;

Malik, I. ;

Mas, J. L. ;

McGuire, A. J. ;

Sidhu, P. ;

Venables, G. ;

Bradbury, A. ;

Brown, M. M. ;

Clifton, A. ;

Gaines, P. ;

Collins, R. ;

Molynewc, A. ;

Naylor, R. ;

Warlow, C. ;

Ferro, J. M. ;

Thomas, D. ;

Bonati, L. H. ;

Coward, L. ;

Dobson, J. ;

Ederle, J. ;

Featherstone, R. F. ;

Tindall, H. ;

McCabe, D. J. H. ;

Wallis, A. ;

Brooks, M. ;

Chambers, B. .

LANCET, 2010, 375 (9719) :985-997

[8] Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial [J].

Ederle, Joerg ;

Bonati, Leo H. ;

Dobson, Joanna ;

Featherstone, Roland L. ;

Gaines, Peter A. ;

Beard, Jonathan D. ;

Venables, Graham S. ;

Markus, Hugh S. ;

Clifton, Andrew ;

Sandercock, Peter ;

Brown, Martin M. .

LANCET NEUROLOGY, 2009, 8 (10) :898-907

[9] Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European carotid surgery trial (ECST) [J].

Farrell, B ;

Fraser, A ;

Sandercock, P ;

Slattery, J ;

Warlow, CP .

LANCET, 1998, 351 (9113) :1379-1387

[10] Outcomes of carotid stenting compared with endarterectomy are equivalent in asymptomatic patients and inferior in symptomatic patients [J].

Giacovelli, Jeannine K. ;

Egorova, Natalia ;

Dayal, Rajeev ;

Gelijns, Annetine ;

McKinsey, James ;

Kent, K. Craig .

JOURNAL OF VASCULAR SURGERY, 2010, 52 (04) :906-913

← 1 2 3 →