Salinas-Aragón MÁ, Palacios-Rodríguez JM, García-Gutiérrez JC, García-Bonilla J, Becerra-Laguna CA, Córdova-Correa H, López-López HA

Language: English
References: 29
Page: 34-43
PDF size: 258.93 Kb.

ABSTRACT

Objective: To describe gender differences in adult patients undergoing carotid angioplasty and its relation to morbidity and mortality at 30 days and 6 months. Material and methods: An observational study from the WHO database comprehending all patients underwent carotid angioplasty in the Department of Hemodynamics Coronary and Peripheral Artery Intervention, Cardiology Hospital 34, IMSS, Monterrey, was conducted in order to ASSESS the differences between genders and their relationship to primary end points within 30 days after the intervention, which were defined as the presence of death related to the procedure, major cerebrovascular event, or myocardial infarction. Results: 279/341 patients/lesions were included for analysis. Within baseline characteristics, women had significantly higher prevalence of type 2 diabetes mellitus (61.4 versus 45.4%, p = 0.006), prior renal angioplasty (21.9 versus 11.5%, p = 0.015), right carotid condition (65.8 versus 53.7%, p = 0.03), prior stroke (20.2 versus 34.4%, p = 0.007) and higher EuroSCORE (3.13 ± 1.72 versus 2.4 ± 1.26, p ‹ 0.001). The masculine gender was only associated with smoking (69.2 versus 35.1%, p ‹ 0.001). In univariate analysis, the female gender was associated with major fatal and non-fatal stroke (4.4 versus 0.9%, p = 0.031). According to symptomatology and subgroups, we found a significant association between women with asymptomatic Increased risk of major cardiovascular events when compared to asymptomatic diseases (9.5 versus 1.4%, p = 0.004). Conclusions: In our center, women who underwent carotid angioplasty present more comorbidities and higher risk in comparison with the male gender. However, these differences do not impact on most adverse cardiovascular events (MACVE) at 30 days. In the subgroup of asymptomatic patients, the risk of major cardiovascular events is significantly higher in the female gender.

REFERENCES

1. Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK. Updated society for vascular surgery guidelines for management of extracranial carotid disease. J Vasc Surg. 2011; 54: e1-31.

2. Carotid Stenting Trialists’ Collaboration, Bonati LH, Dobson J, Algra A, Branchereau A, Chatellier G et al. Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned metaanalysis of individual patient data. Lancet. 2010; 376: 1062-1073.

3. Eckstein HH, Ringleb P, Allenberg JR, Berger J, Fraedrich G, Hacke W et al. Results of the stent-protected angioplasty versus carotid endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomized trial. Lancet Neurol. 2008; 7: 893-902.

4. Goldstein LJ, Khan HU, Sambol EB, Kent KC, Faries PL, Vouyouka AG. Carotid artery stenting is safe and associated with comparable outcomes in men and women. J Vasc Surg. 2009; 49: 315-324.

5. Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ; Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet. 2004; 363: 915-924.

6. Alamowitch S, Eliasziw M, Barnett HJ et al. The risk and benefit of endarterectomy in women with symptomatic internal carotid artery disease. Stroke. 2005; 36: 27-31.

7. Rothwell PM, Goldstein LB. Carotid endarterectomy for asymptomatic carotid stenosis: asymptomatic carotid surgery trial. Stroke. 2004; 35: 2425-2427.

8. Rockman CB, Garg K, Jacobowitz GR et al. Outcome of carotid artery interventions among female patients, 2004 to 2005. J Vasc Surg. 2011; 53 (6): 1457-1464.

9. Howard VJ, Lutsep HL, Mackey A et al. Influence of sex on outcomes of stenting versus endarterectomy: a subgroup analysis of the carotid revascularization endarterectomy versus stenting trial (CREST). Lancet Neurol. 2011; 10 (6): 530-537.

10. Vouyouka AG, Egorova NN, Sosunov EA et al. Analysis of Florida and New York state hospital discharges suggests that carotid stenting in symptomatic women is associated with significant increase in mortality and perioperative morbidity compared with carotid endarterectomy. J Vasc Surg. 2012; 56 (2): 334-342.

11. Bisdas T, Egorova N, Moskowitz AJ et al. The impact of gender on in-hospital outcomes after carotid endarterectomy or stenting. Eur J Vasc Endovasc Surg. 2012; 44 (3): 244-250.

12. Kasner SE. Clinical interpretation of use of stroke scales. Lancet Neurol. 2006; 5: 603-612.

13. Palacios-Rodríguez JM, Bazzoni-Ruiz A, Torres-Hernández M et al. Stentcarotídeo en pacientes de alto riesgo: seguimiento a largo plazo. Rev Mex Cardiol. 2004; 15: 5-13.

14. Lozano R, Naghavi M, Foreman K et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380: 2095-2128.

15. Go AS, Mozaffarian D, Roger VL et al. Heart disease and stroke statistics 2013 update: a report from the American Heart Association. Circulation. 2013; 127: e6-e245.

16. Ovbiagele B, Goldstein LB, Howard VJ et al. Forecasting the future of stroke in the United States a policy statement from the American Heart Association and American Stroke Association. Stroke. 2013; 44: 2361-2375.

17. Roger VL, Go AS, Lloyd-Jones DM. Heart disease and stroke statistics 2012 update: a report from the American Heart Association. Circulation. 2012; 125: e2-e220.

18. Cantú C, Ruiz JL, Arauz A et al. Prevalencia de estenosis carotídea en pacientes con isquemia cerebral transitoria en México. Rev Mex Neuroci. 2010; 11 (5): 343-348.

19. Cantú C, Ruiz JL, Arauz A et al. Factores de riesgo, causas y pronóstico de los tipos de enfermedad vascular cerebral en México: estudio RENAMEVASC. Rev Mex Neuroci. 2011; 12 (5): 224-234.

20. Young B, Moore WS, Robertson JT, Toole JF, Ernst CB, Cohen SN et al An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study. ACAS Investigators. Asymptomatic Carotid Atherosclerosis Study. Stroke. 1996; 27: 2216-2224

21. Stingele R, Berger J, Alfke K, Eckstein HH, Fraedrich G, Allenberg J et al. Clinical and angiographic risk factors for stroke and death within 30 days after carotid endarterectomy and stent-protected angioplasty: a subanalysis of the SPACE study. Lancet Neurol. 2008; 7: 216-222.

22. International Carotid Stenting Study investigators, Ederle J, Dobson J, Featherstone RL, Bonati LH, van der Worp HB et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet. 2010; 375: 985-997.

23. Howard VJ, Voeks JH, Lutsep HL et al. Does sex matter? Thirty-day stroke and death rates after carotid artery stenting in women versus men: results from the carotid revascularization endarterectomy versus stenting trial (CREST) lead-in phase. Stroke. 2009; 40: 1140-1147.

24. Messé SR, Kasner SE, Mehta Z, Warlow CP, Rothwell PM; European Carotid Surgery Trialists. Effect of body size on operative risk of carotid endarterectomy. J Neurol Neurosurg Psychiatry. 2004; 75: 1759-1761.

25. Bond R, Rerkasem K, Cuffe R, Rothwell PM. A systematic review of the associations between age and sex and the operatives risks of carotid endarterectomy. Cerebrovasc Dis. 2005; 20: 69-77.

26. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991; 325: 445-453.

27. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998; 351: 1379-1387.

28. Rothwell PM, Slattery J, Warlow CP. Clinical and angiographic predictors of stroke and death due to carotid endarterectomy. BMJ. 1997; 315: 1571-1577.

29. Hellings WE, Pasterkamp G, Verhoeven BA, De Kleijn DP, De Vries JP, Seldenrijk KA et al. Gender-associated differences in plaque phenotype of patients undergoing carotid endarterectomy. J Vasc Surg. 2007; 45: 289-296.