Abstract 3957: Do Men And Women Undergoing Carotid Endarterectomy Or Carotid Stent Placement In General Practice Have Different Outcomes

Abstract

Background: Data derived from Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) suggested differential comparative periprocedural benefit between carotid angioplasty and stent placement (CAS) and carotid endarterectomy (CEA) on basis of gender. We sought to investigate the impact of gender on post-procedural outcomes of CAS and CEA in general practice at a national level. Methods: We analyzed the data from the Nationwide Inpatient Sample (NIS) which is representative of all admissions in the United States from 2005-2009. The primary end point was occurrence of stroke, cardiac complications, or death during the post procedural period. Outcomes of interest were compared between men and women, undergoing CEA and CAS. Multivariate logistic regression was performed to determine the effect of gender on occurrence of post-operative stroke, cardiac complications, or death for CAS and CEA separately. Covariates included in the logistic regression were patient’s age, gender, co-morbid conditions including hypertension, diabetes mellitus, chronic lung disease, coronary artery disease, congestive heart failure, and renal failure; symptom status (symptomatic versus asymptomatic status), and hospital characteristics. Results: Of the total 673,170 estimated patients, who received CEA or CAS for carotid artery disease during the study period, 591,543 (88%) underwent CEA and the remaining 81627 (12%) underwent CAS. Out of a total of 282,632 (42%) women, 250,502 (89%) women underwent CEA compared to 32130 (11%) women who underwent CAS procedures. There was no difference between men and women in post-operative stroke, cardiac complications, or death for women undergoing CAS for both symptomatic and asymptomatic status as well as symptomatic women undergoing CEA. Post operative strokes (0.99% vs 0.84%, p= 0.01) were higher in asymptomatic women however cardiac complications were higher for asymptomatic men (2.0% vs 1.64%, p= 0.0001) and composite end points was lower in women (2.80% vs 3.00%, p= 0.02) undergoing CEA. In multivariate analysis, gender was not a significant factor for composite end points among patients undergoing either CAS (RR, 95% CI) or CEA (RR, 95% CI) after adjusting for potential confounders. Conclusion: Our analysis suggests that postprocedural rate of events are not significantly different between men and women undergoing either CAS or CEA in general practice and should not be used to determine eligibility for either procedure .