Sex-Based Differences in Ten-Year Nationwide Outcomes of Carotid Revascularization

Jessica M. Mayor, Jason L. Salemi, Deepa Dongarwar, Hamisu M. Salihu, Miguel Montero-Baker, Joseph L Mills, Jayer Chung

Research output: Contribution to journalArticle

Abstract

Background: We compared the rates of stroke, death, and/or MI between men and women, stratified by symptomatic status and procedure type (carotid endarterectomy [CEA]or carotid artery stent [CAS]). Study Design: Using the Nationwide Inpatient Sample, crude and propensity-matched rates of the composite end point of stroke/death/MI were estimated. Multivariable logistic regression was used to calculate the odds of stroke/death/MI associated with sex. Results: Between 2005 and 2015, there were 1,242,688 carotid interventions performed (1,083,912 CEA; 158,776 CAS; 515,789 [41.5%]were female patients). Symptomatic admissions comprised 11.3% of the cohort. In-hospital stroke/death/MI rates were more prevalent in men compared with women (4.2% vs 3.9%; p < 0.01). Subgroup analysis revealed symptomatic women vs men had higher rates of stroke after CEA (7.7% vs 6.2%; p < 0.01)and CAS (9.9% vs 7.6%; p < 0.01). Asymptomatic women experienced the same rates of stroke after either CEA (0.3% vs 0.3%; p = 0.051)or CAS (0.4% vs 0.5%; p = 0.09). Propensity-matched logistic regression revealed that symptomatic males vs females had lower odds of stroke after CEA (odds ratio [OR]0.81; 95% CI 0.72 to 0.91)and CAS (OR 0.72; 95% CI 0.57 to 0.90). Asymptomatic men and women had similar odds of stroke after both CEA (OR 0.95; 95% CI 0.79 to 1.14)and CAS (OR 0.70; 95% CI 0.43 to 1.13). Conclusions: This is the largest cohort study to date that demonstrates asymptomatic women undergoing CEA or CAS do not have a higher risk of perioperative stroke, death, or MI. Symptomatic men experience lower rates of stroke after CEA or CAS.

Original languageEnglish (US)
JournalJournal of the American College of Surgeons
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Sex Characteristics
Carotid Endarterectomy
Carotid Arteries
Stroke
Stents
Odds Ratio
Logistic Models
Mortality
Inpatients
Cohort Studies

ASJC Scopus subject areas

  • Surgery

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Sex-Based Differences in Ten-Year Nationwide Outcomes of Carotid Revascularization. / Mayor, Jessica M.; Salemi, Jason L.; Dongarwar, Deepa; Salihu, Hamisu M.; Montero-Baker, Miguel; Mills, Joseph L; Chung, Jayer.

In: Journal of the American College of Surgeons, 01.01.2019.

Research output: Contribution to journalArticle

Mayor, Jessica M. ; Salemi, Jason L. ; Dongarwar, Deepa ; Salihu, Hamisu M. ; Montero-Baker, Miguel ; Mills, Joseph L ; Chung, Jayer. / Sex-Based Differences in Ten-Year Nationwide Outcomes of Carotid Revascularization. In: Journal of the American College of Surgeons. 2019.
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abstract = "Background: We compared the rates of stroke, death, and/or MI between men and women, stratified by symptomatic status and procedure type (carotid endarterectomy [CEA]or carotid artery stent [CAS]). Study Design: Using the Nationwide Inpatient Sample, crude and propensity-matched rates of the composite end point of stroke/death/MI were estimated. Multivariable logistic regression was used to calculate the odds of stroke/death/MI associated with sex. Results: Between 2005 and 2015, there were 1,242,688 carotid interventions performed (1,083,912 CEA; 158,776 CAS; 515,789 [41.5{\%}]were female patients). Symptomatic admissions comprised 11.3{\%} of the cohort. In-hospital stroke/death/MI rates were more prevalent in men compared with women (4.2{\%} vs 3.9{\%}; p < 0.01). Subgroup analysis revealed symptomatic women vs men had higher rates of stroke after CEA (7.7{\%} vs 6.2{\%}; p < 0.01)and CAS (9.9{\%} vs 7.6{\%}; p < 0.01). Asymptomatic women experienced the same rates of stroke after either CEA (0.3{\%} vs 0.3{\%}; p = 0.051)or CAS (0.4{\%} vs 0.5{\%}; p = 0.09). Propensity-matched logistic regression revealed that symptomatic males vs females had lower odds of stroke after CEA (odds ratio [OR]0.81; 95{\%} CI 0.72 to 0.91)and CAS (OR 0.72; 95{\%} CI 0.57 to 0.90). Asymptomatic men and women had similar odds of stroke after both CEA (OR 0.95; 95{\%} CI 0.79 to 1.14)and CAS (OR 0.70; 95{\%} CI 0.43 to 1.13). Conclusions: This is the largest cohort study to date that demonstrates asymptomatic women undergoing CEA or CAS do not have a higher risk of perioperative stroke, death, or MI. Symptomatic men experience lower rates of stroke after CEA or CAS.",
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AU - Mayor, Jessica M.

AU - Salemi, Jason L.

AU - Dongarwar, Deepa

AU - Salihu, Hamisu M.

AU - Montero-Baker, Miguel

AU - Mills, Joseph L

AU - Chung, Jayer

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