Women have similar procedural success as men after peripheral interventions, despite more severe disease

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Women could be at higher risk for adverse outcomes than men, but overall they have similar procedural success compared with men despite higher complications rates, data from a study published in Journal of the American College of Cardiology in June suggests.

In the study, outcomes of lower extremity peripheral vascular interventions in women were associated with a higher rate of vascular complications, transfusions, and embolism, but there were no differences observed for in-hospital death, myocardial infarction, stroke or transient ischaemic attack.

Elizabeth Jackson, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, USA, and colleagues set out to examine sex-related differences in outcomes related to peripheral vascular intervention procedures since percutaneous peripheral vascular interventions are frequently performed to treat peripheral arterial disease. “However, little is known about sex-related differences related to peripheral vascular intervention procedures,” the authors wrote explaining why they undertook the study.

The investigators assessed the impact of sex among 12,379 patients (41% female) who underwent lower extremity peripheral vascular interventions from 2004 to 2009 at 16 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium Peripheral Vascular Interventions registry. They carried out a multivariate propensity-matched analyses to adjust for differences in baseline characteristics, procedural indications, and comorbidities on the basis of sex.

“We found that women had excellent outcomes compared to men, even though they were older and had more severe disease,” said senior study author P Michael Grossman, an interventional cardiologist at the University of Michigan Frankel Cardiovascular Center and director of the cardiac catheterization laboratory at the Veterans Administration Ann Arbor Healthcare System.

“Compared with men, women were older at the time of the procedure and have multilevel disease and critical limb ischemia. In a propensity-matched analysis, female sex was associated with a higher rate of vascular complications, transfusions, and embolism. No differences were observed for in-hospital death, myocardial infarction, or stroke or transient ischemic attack. Technical success was more commonly achieved in women (91.2% vs. 89.1%, p=0.014), but because of a higher complication rate, the overall procedural success rates were similar in men and women (79.7% vs. 81.6%, p=0.08),” Jackson and colleagues wrote.

In a press release from University of Michigan Health System, the researchers noted that it was surprising to observe no gender-related differences in procedural success considering that women experienced more transfusions, vascular complications and embolisms.

The authors therefore concluded that women represent a significant proportion of patients undergoing lower-extremity peripheral vascular interventions, have a more severe and complex disease process, and are at increased risk for adverse outcomes. Despite higher complications rates, women had similar procedural success compared with men, making peripheral vascular intervention an effective treatment strategy among women with lower extremity peripheral arterial disease.

“The data suggests women may benefit to a greater degree with an invasive percutaneous strategy for the management of peripheral arterial disease, particularly if complications can be avoided,” said study author Elizabeth Jackson, cardiologist and director of the University of Michigan Women’s Heart Program.

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