Female Sex is Associated with More Reinterventions after Endovascular and Open Interventions for Intermittent Claudication.
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Oct 2022
Oct 2022
Historique:
received:
17
03
2022
revised:
18
05
2022
accepted:
19
05
2022
pubmed:
10
7
2022
medline:
15
11
2022
entrez:
9
7
2022
Statut:
ppublish
Résumé
Intermittent claudication (IC) is a commonly treated vascular condition. Patient sex has been shown to influence outcomes of interventions for other vascular disorders; however, whether outcomes of interventions for IC vary by sex is unclear. We sought to assess the association of patient sex with outcomes after IC interventions. The Vascular Quality Initiative was queried from 2010-2020 for all peripheral endovascular interventions (PVI), infra-inguinal bypasses (IIB), and supra-inguinal bypasses (SIB) for any degree IC. Univariable and multivariable analyses compared peri-operative and long-term outcomes by patient sex. There were 24,701 female and 40,051 male patients undergoing PVI, 2,789 female and 6,525 male patients undergoing IIB, and 1,695 female and 2,370 male patients undergoing SIB for IC. Guideline-recommended pre-operative medical therapy differed with female patients less often prescribed aspirin for PVI (73.4% vs. 77.3%), IIB (71.5% vs. 74.8%), and SIB (70.9% vs. 74.3%) or statins for PVI (71.8% vs. 76.7%) and IIB (73.1% vs. 76.0%) (all P < 0.05). Female compared with male patients had lower 1-year reintervention-free survival after PVI (84.4% ± 0.3% vs. 86.3% ± 0.2%, P < 0.001), IIB (79.0% ± 0.9% vs. 81.2% ± 0.6%, P = 0.04), and SIB (89.4% ± 0.9% vs. 92.6% ± 0.7%, P = 0.005), but similar amputation-free survival and survival across all procedures. Multivariable analysis confirmed that female sex was associated with increased 1-year reintervention for PVI (HR 1.16, 95% CI 1.09-1.24, P < 0.001), IIB, (HR 1.16, 95% CI 1.03-1.31, P = 0.02), and SIB (HR 1.60, 95% CI 1.20-2.13, P = 0.001). Female patients undergoing interventions for IC were less often pre-operatively medically optimized than male patients, though the difference was small. Furthermore, female sex was associated with more reinterventions after interventions. Interventionists treating female patients should increase their efforts to maximize medical therapy. Future research should clarify reasons for poorer intervention durability in female patients.
Sections du résumé
BACKGROUND
BACKGROUND
Intermittent claudication (IC) is a commonly treated vascular condition. Patient sex has been shown to influence outcomes of interventions for other vascular disorders; however, whether outcomes of interventions for IC vary by sex is unclear. We sought to assess the association of patient sex with outcomes after IC interventions.
METHODS
METHODS
The Vascular Quality Initiative was queried from 2010-2020 for all peripheral endovascular interventions (PVI), infra-inguinal bypasses (IIB), and supra-inguinal bypasses (SIB) for any degree IC. Univariable and multivariable analyses compared peri-operative and long-term outcomes by patient sex.
RESULTS
RESULTS
There were 24,701 female and 40,051 male patients undergoing PVI, 2,789 female and 6,525 male patients undergoing IIB, and 1,695 female and 2,370 male patients undergoing SIB for IC. Guideline-recommended pre-operative medical therapy differed with female patients less often prescribed aspirin for PVI (73.4% vs. 77.3%), IIB (71.5% vs. 74.8%), and SIB (70.9% vs. 74.3%) or statins for PVI (71.8% vs. 76.7%) and IIB (73.1% vs. 76.0%) (all P < 0.05). Female compared with male patients had lower 1-year reintervention-free survival after PVI (84.4% ± 0.3% vs. 86.3% ± 0.2%, P < 0.001), IIB (79.0% ± 0.9% vs. 81.2% ± 0.6%, P = 0.04), and SIB (89.4% ± 0.9% vs. 92.6% ± 0.7%, P = 0.005), but similar amputation-free survival and survival across all procedures. Multivariable analysis confirmed that female sex was associated with increased 1-year reintervention for PVI (HR 1.16, 95% CI 1.09-1.24, P < 0.001), IIB, (HR 1.16, 95% CI 1.03-1.31, P = 0.02), and SIB (HR 1.60, 95% CI 1.20-2.13, P = 0.001).
CONCLUSIONS
CONCLUSIONS
Female patients undergoing interventions for IC were less often pre-operatively medically optimized than male patients, though the difference was small. Furthermore, female sex was associated with more reinterventions after interventions. Interventionists treating female patients should increase their efforts to maximize medical therapy. Future research should clarify reasons for poorer intervention durability in female patients.
Identifiants
pubmed: 35809741
pii: S0890-5096(22)00308-9
doi: 10.1016/j.avsg.2022.05.036
pmc: PMC9846811
mid: NIHMS1860824
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
85-93Subventions
Organisme : NIDDK NIH HHS
ID : K23 DK124515
Pays : United States
Informations de copyright
Copyright © 2022 Elsevier Inc. All rights reserved.
Références
Eur Heart J. 2018 Mar 1;39(9):763-816
pubmed: 28886620
J Vasc Surg. 2017 Mar;65(3):889-906.e4
pubmed: 28236929
Gend Med. 2008 Mar;5(1):53-61
pubmed: 18420166
J Vasc Surg. 2021 Aug;74(2):499-504
pubmed: 33548437
Ann Surg. 2019 Oct;270(4):630-638
pubmed: 31356266
J Vasc Surg. 2014 Feb;59(2):409-418.e3
pubmed: 24080134
J Vasc Surg. 2015 Mar;61(3 Suppl):2S-41S
pubmed: 25638515
J Vasc Surg. 2020 Feb;71(2):374-381
pubmed: 31280978
Ann Vasc Med Res. 2020;7(4):
pubmed: 33585679
J Vasc Surg. 2018 Jul;68(1):153-160
pubmed: 29276108
Clin Cardiol. 2005 Aug;28(8):389-93
pubmed: 16144216
J Vasc Surg. 2018 Sep;68(3):796-806.e1
pubmed: 29523437
JACC Cardiovasc Interv. 2020 Dec 28;13(24):2911-2918
pubmed: 33357529
J Vasc Surg. 2021 May;73(5):1759-1768.e1
pubmed: 33098941
J Vasc Surg. 2019 Feb;69(2):545-554
pubmed: 30108008
J Vasc Surg. 2018 Aug;68(2):495-502.e1
pubmed: 29506947
J Vasc Surg. 2020 Jul;72(1):241-249
pubmed: 31839346
J Vasc Surg. 2021 Sep;74(3):780-787.e7
pubmed: 33647437
J Vasc Surg. 2012 Apr;55(4):1001-7
pubmed: 22301210
J Vasc Surg. 2020 May;71(5):1587-1594.e2
pubmed: 32014286
J Vasc Surg. 2017 Jul;66(1):2-8
pubmed: 28259576
J Am Heart Assoc. 2019 Sep 3;8(17):e013088
pubmed: 31475624
Eur J Vasc Endovasc Surg. 2018 Mar;55(3):305-368
pubmed: 28851596