Abstract 12605: Sex Differences in Cardiovascular Revascularization Strategies and Outcomes in Dialysis Patients

Abstract

Background: Coronary artery disease is the leading cause of mortality in patients with kidney failure. Little is known about sex differences in revascularization strategies and the associated risk of death in dialysis patients. Methods: We evaluated 60,492 patients who initiated dialysis between 1/1/2005 and 12/31/2018 and had at least one hospitalization with a primary diagnosis of an acute coronary syndrome (ACS), using the United States Renal Data System with linked Medicare claims, we examined the association of sex with initial cardiac revascularization (defined as coronary artery bypass graft [CABG], percutaneous coronary intervention [PCI], or both on the same day) within 30 days of the first ACS hospitalization using adjusted multinomial regression, and the association of sex and initial cardiac revascularization on the outcomes of all-cause death and myocardial infarction using adjusted time-to-event models. Results: The mean age of patients at index ACS hospitalization was 72±11 years, and 40.4% were women. Overall, 40.5% received PCI, 20.8% received CABG, and 6.1% received both CABG and PCI. After an index ACS event, as compared to no revascularization, women as compared to men had a 41% lower likelihood of receiving CABG (OR, 0.59; 95% CI, 0.56-0.62), 13% lower likelihood of receiving PCI (OR, 1.48; 95% CI, 1.42-1.55), and 41% lower likelihood of receiving CABG and PCI (OR, 0.59; 95% CI, 0.55-0.64). Women had a slightly lower risk of all-cause death during the follow-up period than men without treatment (HR, 0.87; 95% CI, 0.85-0.90) or after receiving PCI (HR, 0.94; 95% CI, 0.90-0.97), but no difference in all-cause death after receiving CABG, and after receiving both CABG and PCI. Women had a higher risk of having MI after receiving CABG (HR, 1.12; 95% CI, 1.05-1.19), and a lower risk of MI after receiving PCI. Conclusion: Among patients undergoing dialysis with ACS, women receive less treatment with CABG or PCI than men. Women have a lower adjusted risk of all-cause mortality with PCI, a lower risk of MI after PCI, and a higher adjusted risk of MI with CABG, as compared to men. Revascularization strategies for CV disease may need to be modified based on sex.