Impact of Gender on In-Hospital Outcomes Following Contemporary Percutaneous Intervention for Peripheral Arterial Disease
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Abstract
Background. Percutaneous peripheral arterial intervention (PPAI) has emerged as an effective and less invasive alternative to surgery for peripheral arterial disease (PAD), however, data on gender differences in outcome of PPAI, especially in the stent era, are limited. The purpose of this study was to assess the gender differences on in-hospital outcomes of patients undergoing PPAI. Methods. We analyzed data on 268 consecutive patients (women: 122; men: 146) who underwent PPAI for PAD between October 2001 and January 2004. A total of 405 lesions (women: 184; men: 221) were treated. Results. Background characteristics were similar except for less prevalent prior coronary intervention in women (18.0% versus 28.8%, P = 0.04), and more prevalent current smokers in women (22.1% versus 12.3%; P = 0.03). Upper extremities interventions were performed more often in women (9.2% versus 3.2%; P = 0.01). Procedure success was achieved in 89.3% of women and 89.7% of men (P = NS). In-hospital mortality was similar between women and men (1.6% versus 0.7%; P = NS). However, hemorrhagic complications occurred more frequently in women (7.4% versus 0.7%; p = 0.006). The blood transfusion rate was significantly higher in women (6.6% versus 0.7%; P = 0.013). Female gender was the only independent predictor of hemorrhagic complications (OR = 12.2; 95% CI = 1.39–111.1; p = 0.024). Conclusions. Percutaneous intervention for PAD can be performed in women with similar success rates as in men, albeit with a greater than 10-fold higher risk of hemorrhagic complications.
Vascular Disease Management 2005;2(5):154–158
Key words: women, angioplasty, stent, bleeding, complications
Women with coronary artery disease (CAD) are known to have a higher prevalence of co-morbidities than men, including advanced age, hypertension, diabetes and concomitant non-cardiac disease. Female gender has been shown to be an independent risk factor for morbidity and mortality after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI),1,2 although this gender difference is diminishing with improvement in new techniques, technology advancements and pharmacologic treatments.3–5
Peripheral arterial disease (PAD) is a subclinical marker of CAD and is equally prevalent in men and women over age 40.6 Women undergoing surgery for PAD have a higher risk of perioperative myocardial infarction (MI), vascular complications and bleeding.7–9 Percutaneous peripheral arterial intervention (PPAI) has emerged as an effective and less invasive alternative to surgical therapy, however, data on gender differences on outcomes of PPAI for PAD, especially in the stent era, are limited.
The purpose of this study was to assess the gender differences in the characteristics and in-hospital outcomes of patients undergoing PPAI for PAD in a single center.
Methods
Patient population. We analyzed data on 268 consecutive patients who underwent PPAI for PAD (excluding carotid angioplasty, endovascular aortic aneurysm repair, or concomitant coronary intervention) in the cardiac catheterization laboratory between October 2001 and January 2004 at a single center. All procedures were performed by 3 interventional cardiologists experienced in peripheral endovascular interventions.
Procedure. Arterial access was obtained via the femoral or brachial approach for all procedures. Percutaneous procedures were performed using rheolytic thrombectomy, balloons or stents, with distal protection device use at the discretion of the operators. Anticoagulation was achieved using either weight-adjusted heparin or bivalirudin to achieve the activated clotting time (ACT) between 250–300 seconds. Femoral arterial sheaths were removed either manually when the ACT was < 180 seconds, or using an approved arteriotomy closure device such as The Closer™ (Perclose Inc., Redwood City, California) or Angio-Seal™ (St. Jude Medical Inc., St. Paul, Minnesota) after selective femoral arteriography confirmed the appropriate insertion site and size of the common femoral artery. All patients with clinical suspicion of a false aneurysm, arteriovenous fistula and retroperitoneal hemorrhage were subjected to ultrasound imaging of the femoral artery or an abdominal computed tomography scan. The NCDR database and the patients’ charts were used for data collection.
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