Impact of Gender on Outcomes for Lower Extremity PAD Interventions Studied

April 23, 2014—Elizabeth A. Jackson, MD, et al conducted an evaluation of the impact of gender on morbidity and mortality rates following lower extremity interventions for peripheral arterial disease (PAD). The findings of these observations from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium were published online ahead of print in the Journal of the American College of Cardiology (JACC).

The investigators noted that the study’s background is that although percutaneous peripheral vascular intervention (PVI) is frequently performed for the treatment of PAD, little is known about gender-related differences associated with PVI procedures.

As summarized in JACC, the investigators assessed the impact of gender among 12,379 patients (41% female) who underwent lower extremity (LE)-PVI from 2004 to 2009 at 16 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PVI registry. Multivariate propensity matched analyses were performed to adjust for differences in baseline characteristics, procedural indications, and comorbidities based on gender.

The investigators reported that compared with men, women were older and had multilevel disease and critical limb ischemia. In a propensity-matched analysis, female sex was associated with a higher rate of vascular complications, transfusions, and embolism. No differences were observed for in-hospital death, myocardial infarction, or stroke/transient ischemic attack. Technical success was more commonly achieved in women (91.2% vs 89.1%; P = .014) but because of a higher complication rate, the overall procedural success rates were similar in men and women (79.7% vs 81.6%; P = .08).

These findings showed that women represent a significant proportion of patients undergoing LE-PVI, have more severe and complex disease processes, and are at increased risk for adverse outcomes. Despite higher complications rates, women had similar procedural success compared with men, making PVI an effective treatment strategy among women with PAD of the lower extremity, concluded the investigators in JACC.