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Cardiovasc Revasc Med. 2019 Mar 27. pii: S1553-8389(19)30222-2. doi: 10.1016/j.carrev.2019.03.018. [Epub ahead of print]

Assessment of sex differences in 5-year clinical outcomes following endovascular revascularization for peripheral artery disease.

Author information

1
Division of Cardiology, UCLA Medical Center, Los Angeles, CA, United States of America.
2
Department of Medicine, Korea University Graduate School, Seoul, Republic of Korea.
3
Department of Plastic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea.
4
Department of Thoracic and Cardiovascular Surgery, Korea University Graduate School, Seoul, Republic of Korea.
5
Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea.
6
Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea. Electronic address: swrha617@yahoo.co.kr.

Abstract

Percutaneous transluminal angioplasty (PTA) is an effective treatment strategy for peripheral artery disease (PAD). Data are limiting regarding sex differences in patients with PAD who underwent PTA. We assessed the sex-related differences on 5-year clinical outcomes in patients with PAD who underwent PTA. We prospectively evaluated 765 patients with PAD (596 males and 169 females) who underwent PTA. We performed propensity score matching (PSM) analysis to adjust for any potential confounders. The primary endpoints were 5-year major adverse cardiac and cerebrovascular events (MACE) and major adverse lower-limb events (MALE) assessed by Kaplan-Meier curved analysis and log rank test. After PSM analysis, baseline clinical characteristics were similar in male and female patients. There was a trend toward a higher rate of major hematoma in female patients (6.1% vs. 0.9%, p = 0.066) and a lower rate of below the ankle amputation (24.7% vs. 16.5%, p = 0.097). During the 5-year clinical follow-up, male and female patients had similar rates of MACE (14.9% vs. 15.8%, log rank p = 0.838) and MALE (34.8% vs. 28.2%, log rank p = 0.264) as well as the individual endpoints. In subgroup analysis adjusted by PSM, female patients had a higher risk of bleeding complications in age ≥ 65 years, hypertension, diabetes mellitus, chronic kidney disease, and in the non-critical limb ischemia patients. Of patients with preserved renal function, female patients had a higher risk of MALE as compared to males. In conclusion, female patients with PAD who underwent PTA showed similar 5-year MACE and MALE compared with male patients.

KEYWORDS:

Clinical outcomes; Critical limb ischemia; Endovascular therapy; Percutaneous transluminal angioplasty; Peripheral artery disease; Sex

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