Sex Differences in Outcomes Following Endovascular Treatment for Symptomatic Peripheral Artery Disease

An Analysis From the K- VIS ELLA Registry

K‐VIS Investigators

Research output: Contribution to journalArticle

Abstract

Background With advances in peripheral artery disease ( PAD ) treatments such as endovascular treatment ( EVT ), personalized patient assessment is important. Data on sex differences in clinical outcome for PAD patients undergoing EVT have been limited, and studies have produced conflicting results. This study sought to compare midterm clinical outcomes between women and men in a large population of patients with PAD undergoing EVT . Methods and Results The K- VIS ELLA (Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Disease) registry is a nationwide, multicenter, observational study that includes 3073 PAD patients undergoing EVT . The study population was divided into men (n=2523) and women (n=550). The primary outcome was a composite of death, myocardial infarction, and major amputation; the secondary outcome included major adverse limb events. Women had more comorbidities and more severe and complex target lesions than men. Women showed higher rates of death, myocardial infarction, or major amputation than men (14.8% versus 9.8%, adjusted hazard ratio 1.350, 95% CI 1.017-1.792, P=0.038), and higher rates of major adverse limb events (19.9% versus 14.5%, adjusted hazard ratio 1.301, 95% CI 1.014-1.670, P=0.039) and procedural complications (10.2% versus 5.9%, P<0.001) based on multivariable analysis. In patients with claudication, the primary outcome incidence was significantly higher in women (hazard ratio 2.088, 95% CI 1.421-3.068, P<0.001). In contrast, there was no significant difference in primary outcome for patients with critical limb ischemia between the 2 groups (hazard ratio 1.164, 95% CI 0.800-1.694, P=0.426). A significant interaction ( P=0.035) between patient presentation and outcome was observed. Conclusions In a large population of patients with PAD undergoing EVT , women had higher rates of death, myocardial infarction, or major amputation than men and higher rates of complex lesions, procedural complications, and limb-specific adverse events.

Original languageEnglish
Pages (from-to)e010849
JournalJournal of the American Heart Association
Volume8
Issue number2
DOIs
Publication statusPublished - 2019 Jan 22

Fingerprint

Peripheral Arterial Disease
Sex Characteristics
Registries
Extremities
Amputation
Myocardial Infarction
Therapeutics
Population
Mortality
Multicenter Studies
Observational Studies
Blood Vessels
Comorbidity
Lower Extremity
Ischemia
Arteries
Incidence

Keywords

  • endovascular treatment
  • outcomes
  • percutaneous transluminal angioplasty
  • peripheral artery disease
  • sex

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{cfe343c78d134c459a9116bbd3836286,
title = "Sex Differences in Outcomes Following Endovascular Treatment for Symptomatic Peripheral Artery Disease: An Analysis From the K- VIS ELLA Registry",
abstract = "Background With advances in peripheral artery disease ( PAD ) treatments such as endovascular treatment ( EVT ), personalized patient assessment is important. Data on sex differences in clinical outcome for PAD patients undergoing EVT have been limited, and studies have produced conflicting results. This study sought to compare midterm clinical outcomes between women and men in a large population of patients with PAD undergoing EVT . Methods and Results The K- VIS ELLA (Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Disease) registry is a nationwide, multicenter, observational study that includes 3073 PAD patients undergoing EVT . The study population was divided into men (n=2523) and women (n=550). The primary outcome was a composite of death, myocardial infarction, and major amputation; the secondary outcome included major adverse limb events. Women had more comorbidities and more severe and complex target lesions than men. Women showed higher rates of death, myocardial infarction, or major amputation than men (14.8{\%} versus 9.8{\%}, adjusted hazard ratio 1.350, 95{\%} CI 1.017-1.792, P=0.038), and higher rates of major adverse limb events (19.9{\%} versus 14.5{\%}, adjusted hazard ratio 1.301, 95{\%} CI 1.014-1.670, P=0.039) and procedural complications (10.2{\%} versus 5.9{\%}, P<0.001) based on multivariable analysis. In patients with claudication, the primary outcome incidence was significantly higher in women (hazard ratio 2.088, 95{\%} CI 1.421-3.068, P<0.001). In contrast, there was no significant difference in primary outcome for patients with critical limb ischemia between the 2 groups (hazard ratio 1.164, 95{\%} CI 0.800-1.694, P=0.426). A significant interaction ( P=0.035) between patient presentation and outcome was observed. Conclusions In a large population of patients with PAD undergoing EVT , women had higher rates of death, myocardial infarction, or major amputation than men and higher rates of complex lesions, procedural complications, and limb-specific adverse events.",
keywords = "endovascular treatment, outcomes, percutaneous transluminal angioplasty, peripheral artery disease, sex",
author = "{K‐VIS Investigators} and Choi, {Ki Hong} and Park, {Taek Kyu} and Jihoon Kim and Ko, {Young Guk} and Yu, {Cheol Woong} and Yoon, {Chang Hwan} and Lee, {Jae Hwan} and Min, {Pil Ki} and Koh, {Yoon Seok} and Chae, {In Ho} and Donghoon Choi and Choi, {Seung Hyuk}",
year = "2019",
month = "1",
day = "22",
doi = "10.1161/JAHA.118.010849",
language = "English",
volume = "8",
pages = "e010849",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Sex Differences in Outcomes Following Endovascular Treatment for Symptomatic Peripheral Artery Disease

T2 - An Analysis From the K- VIS ELLA Registry

AU - K‐VIS Investigators

AU - Choi, Ki Hong

AU - Park, Taek Kyu

AU - Kim, Jihoon

AU - Ko, Young Guk

AU - Yu, Cheol Woong

AU - Yoon, Chang Hwan

AU - Lee, Jae Hwan

AU - Min, Pil Ki

AU - Koh, Yoon Seok

AU - Chae, In Ho

AU - Choi, Donghoon

AU - Choi, Seung Hyuk

PY - 2019/1/22

Y1 - 2019/1/22

N2 - Background With advances in peripheral artery disease ( PAD ) treatments such as endovascular treatment ( EVT ), personalized patient assessment is important. Data on sex differences in clinical outcome for PAD patients undergoing EVT have been limited, and studies have produced conflicting results. This study sought to compare midterm clinical outcomes between women and men in a large population of patients with PAD undergoing EVT . Methods and Results The K- VIS ELLA (Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Disease) registry is a nationwide, multicenter, observational study that includes 3073 PAD patients undergoing EVT . The study population was divided into men (n=2523) and women (n=550). The primary outcome was a composite of death, myocardial infarction, and major amputation; the secondary outcome included major adverse limb events. Women had more comorbidities and more severe and complex target lesions than men. Women showed higher rates of death, myocardial infarction, or major amputation than men (14.8% versus 9.8%, adjusted hazard ratio 1.350, 95% CI 1.017-1.792, P=0.038), and higher rates of major adverse limb events (19.9% versus 14.5%, adjusted hazard ratio 1.301, 95% CI 1.014-1.670, P=0.039) and procedural complications (10.2% versus 5.9%, P<0.001) based on multivariable analysis. In patients with claudication, the primary outcome incidence was significantly higher in women (hazard ratio 2.088, 95% CI 1.421-3.068, P<0.001). In contrast, there was no significant difference in primary outcome for patients with critical limb ischemia between the 2 groups (hazard ratio 1.164, 95% CI 0.800-1.694, P=0.426). A significant interaction ( P=0.035) between patient presentation and outcome was observed. Conclusions In a large population of patients with PAD undergoing EVT , women had higher rates of death, myocardial infarction, or major amputation than men and higher rates of complex lesions, procedural complications, and limb-specific adverse events.

AB - Background With advances in peripheral artery disease ( PAD ) treatments such as endovascular treatment ( EVT ), personalized patient assessment is important. Data on sex differences in clinical outcome for PAD patients undergoing EVT have been limited, and studies have produced conflicting results. This study sought to compare midterm clinical outcomes between women and men in a large population of patients with PAD undergoing EVT . Methods and Results The K- VIS ELLA (Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Disease) registry is a nationwide, multicenter, observational study that includes 3073 PAD patients undergoing EVT . The study population was divided into men (n=2523) and women (n=550). The primary outcome was a composite of death, myocardial infarction, and major amputation; the secondary outcome included major adverse limb events. Women had more comorbidities and more severe and complex target lesions than men. Women showed higher rates of death, myocardial infarction, or major amputation than men (14.8% versus 9.8%, adjusted hazard ratio 1.350, 95% CI 1.017-1.792, P=0.038), and higher rates of major adverse limb events (19.9% versus 14.5%, adjusted hazard ratio 1.301, 95% CI 1.014-1.670, P=0.039) and procedural complications (10.2% versus 5.9%, P<0.001) based on multivariable analysis. In patients with claudication, the primary outcome incidence was significantly higher in women (hazard ratio 2.088, 95% CI 1.421-3.068, P<0.001). In contrast, there was no significant difference in primary outcome for patients with critical limb ischemia between the 2 groups (hazard ratio 1.164, 95% CI 0.800-1.694, P=0.426). A significant interaction ( P=0.035) between patient presentation and outcome was observed. Conclusions In a large population of patients with PAD undergoing EVT , women had higher rates of death, myocardial infarction, or major amputation than men and higher rates of complex lesions, procedural complications, and limb-specific adverse events.

KW - endovascular treatment

KW - outcomes

KW - percutaneous transluminal angioplasty

KW - peripheral artery disease

KW - sex

UR - http://www.scopus.com/inward/record.url?scp=85060178200&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060178200&partnerID=8YFLogxK

U2 - 10.1161/JAHA.118.010849

DO - 10.1161/JAHA.118.010849

M3 - Article

VL - 8

SP - e010849

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 2

ER -