Sex and outcomes after stenting and endarterectomy in asymptomatic severe carotid stenosis patients.

Autor: Voeks JH; Department of Neurology, Medical University of South Carolina, Charleston, SC, USA. Electronic address: voeks@musc.edu., Panthofer AM; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Electronic address: panthofer@surgery.wisc.edu., Matsumura JS; Division of Vascular Surgery, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: jon.matsumura@cuanschutz.edu., Howard VJ; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: vjhoward@uab.edu., Howard G; Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: ghoward@uab.edu., Roubin GS; Chair, CREST-2 Interventional Management Committee, Jackson, WY, USA. Electronic address: garyroubin@aol.com., Brott TG; Department of Neurology, Mayo Clinic, Jacksonville, FL, USA. Electronic address: brott.thomas@mayo.edu., Rosenfield K; Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA. Electronic address: krosenfield1@mgh.harvard.edu., Hanlon BM; Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA. Electronic address: bmhanlon@wisc.edu.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2024 Nov; Vol. 33 (11), pp. 108004. Date of Electronic Publication: 2024 Sep 14.
DOI: 10.1016/j.jstrokecerebrovasdis.2024.108004
Abstrakt: Objectives: To determine if sex was an effect modifier in a pooled analysis of asymptomatic patients from CREST and ACT I.
Materials and Methods: We analyzed data from 2544 patients aged <80 with ≥70 % asymptomatic carotid stenosis randomized to CAS or CEA (n CREST = 1091; n ACT-1 = 1453). The pre-specified primary endpoint in both trials was any stroke, myocardial infarction or death during the peri-procedural period, or ipsilateral stroke within 4 years of randomization. The secondary endpoint was any stroke or death during the peri-procedural period, or ipsilateral stroke within 4 years of randomization.
Results: There was no significant difference in the frequency of events for men or women between CAS and CEA for the primary or secondary endpoints. When assessing for an interaction of sex and risks between procedures, the treatment-by-sex interaction was not significant for either primary or secondary endpoints in the four-year period or the peri-procedural period. However, women had significantly fewer post-procedural events (ipsilateral stroke) with CAS than CEA (HR = 0.33, 95 % CI: 0.09-1.18) compared to men (HR = 2.09, 95 % CI: 0.78-5.61), p = 0.02 for interaction.
Conclusions: In this large, pooled analysis of asymptomatic patients comparing CAS to CEA, sex did not act as an effect modifier of treatment differences in the four-year primary stroke-MI-or-death endpoint or the secondary stroke-or-death endpoint. However, during the post-procedural period men treated with CAS were at higher risk than their female counterparts.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: JV Research grant from NIH. BH Research grant NIH. GH Research grant from NIH. TB Research grant from the NIH. JSM Research grants from Abbott, Cook, Medtronic, Endologix, Gore, and NIH. GR; InspireMD Inc; Contego Medical Inc. KR Consultant/Scientific Advisory Board: Abbott Vascular; Althea Medical; Angiodynamics; Auxetics; Becton-Dickinson; Boston Scientific; Contego; Crossliner; Imperative Care; Innova Vascular; Inspire MD; Janssen/Johnson and Johnson; Magneto; Mayo Clinic; MedAlliance; Medtronic; Neptune Medical; Penumbra; Philips; Surmodics; Terumo; Thrombolex; Vasorum; Vumedi. Equity: Access Vascular; Aerami; Althea Medical; Auxetics; Contego; Crossliner; Endospan; Imperative Care/Truvic; Innova Vascular; InspireMD; JanaCare; Magneto; MedAlliance; Neptune Medical; Orchestra; PQ Bypass; Prosomnus; Shockwave; Skydance; Summa Therapeutics; Thrombolex; Valcare; Vasorum; Vumedi. Board Member: National PERT Consortium(TM). VJHoward: Research grant from NIH; AMP Declaration of Interest: None.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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