Incidence and Outcomes of Acute Ischemic Stroke Following Percutaneous Coronary Interventions in Men Versus Women

Alkhouli, Mohamad; Alqahtani, Fahad; Elsisy, Mohamed F.; Kawsara, Akram; Alasnag, Mirvat

doi:10.1016/j.amjcard.2019.10.045

Cited by 8 publications

(6 citation statements)

References 18 publications

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“…The procedure-related stroke rate in our study was calculated to be 0.6%, and women are at increased risk (1.2% in women vs. 0.3% in men), which is comparable to real-world registry data [9,35,36]. This increased stroke risk can be attributed to the high prevalence of atrial fibrillation among women as reported in Otsuki et al .…”

Section: Discussionsupporting

confidence: 87%

Sex difference in clinical and procedural outcomes in patients undergoing coronary atherectomy: a systematic review and meta-analysis

Thandra

Pajjuru

Jhand

et al. 2022

Coronary Artery Disease

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Background Rotational and orbital coronary atherectomy (CA) are commonly utilized to treat complex calcified coronary lesions. We conducted a meta-analysis to evaluate sex differences in procedural complications and clinical outcomes after CA. Methods PubMed, Google Scholar, and Cochrane databases were searched for all studies comparing sex differences in procedural and clinical outcomes following CA. The outcomes of interest were procedural complications (coronary dissection, stroke, major bleeding, coronary perforation, cardiac tamponade, and slow or no flow in target vessel) and the clinical outcomes (including early mortality, mid-term all-cause mortality, stroke, myocardial infarction, and target vessel revascularization). Pooled risk ratios (RRs) with their corresponding 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel random-effects model. ResultsSix observational studies with 3517 patients (2420 men and 1035 women) were included in this metaanalysis. While there was no significant difference in the early mortality (RR, 1.14; 95% CI, 0.37-3.53; P = 0.83) between men and women, at a mean follow-up of 2.9 years, all-cause mortality was significantly higher in women (RR, 1.29; 95% CI, 1.11-1.49; P = 0.0009). Women had an increased risk of procedure-related stroke (RR, 3.98; 95% CI, 1.06-14.90; P = 0.04), coronary dissection (RR, 2.10; 95% CI, 1.23-3.58; P = 0.006), and bleeding (RR, 2.26; 95% CI, 1.30-3.93; P = 0.004), whereas the rates of coronary perforation, cardiac tamponade, and the risk of slow or no flow in the revascularized artery were similar in both. ConclusionIn our analysis, women undergoing CA are at increased risk of mid-term mortality and procedurerelated complications including stroke, coronary dissection, and major bleeding.

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Section: Discussionsupporting

confidence: 87%

Sex difference in clinical and procedural outcomes in patients undergoing coronary atherectomy: a systematic review and meta-analysis

Thandra

Pajjuru

Jhand

et al. 2022

Coronary Artery Disease

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“…3,[5][6][7] Although women are often found to have worse outcomes in various acute illnesses than do men, those studies paradoxically suggested better outcomes in COVID-19einfected women than in men. [8][9][10] In the largest survey of 72,314 COVID-19 suspected or confirmed cases in China (men, 63.8% [6387]; women, 36.2% [8325]), the case fatality rate was significantly higher in men than in women (2.8% vs 1.7%). 6 In another study from Italy, among the first 827 COVID-19erelated deaths in the country, 80% were men.…”

mentioning

confidence: 99%

Sex Differences in Case Fatality Rate of COVID-19: Insights From a Multinational Registry

Alkhouli

Nanjundappa

Annie

et al. 2020

Mayo Clinic Proceedings

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125

121

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Objectives: To confirm whether a relationship exists between male sex and coronavirus disease 2019 (COVID-19) mortality and whether this relationship is age dependent. Patients and Methods: We queried the COVID-19 Research Network, a multinational database using the TriNetX network, to identify patients with confirmed COVID-19 infection. The main end point of the study was all-cause mortality. Results: A total of 14,712 patients were included, of whom 6387 (43%) were men. Men were older (mean age, 55.0AE17.7 years vs 51.1AE17.9 years; P<.001) and had a higher prevalence of hypertension, diabetes, coronary disease, obstructive pulmonary disease, nicotine dependence, and heart failure but a lower prevalence of obesity. Before propensity score matching (PSM), all-cause mortality rate was 8.8% in men and 4.3% in women (odds ratio, 2.15; 95% CI, 1.87 to 2.46; P<.001) at a median follow-up duration of 34 and 32 days, respectively. In the Kaplan-Meier survival analysis, the cumulative probability of survival was significantly lower in men than in women (73% vs 86%; log-rank, P<.001). After PSM, all-cause mortality remained significantly higher in men than in women (8.13% vs 4.60%; odds ratio, 1.81; 95% CI, 1.55 to 2.11; P<.001). In the Kaplan-Meier survival analysis, the cumulative probability of survival remained significantly lower in men than in women (74% vs 86%; log-rank, P<.001). The cumulative probability of survival remained significantly lower in propensity scoreematched men than in women after excluding patients younger than 50 years and those who were taking angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications on admission. Conclusion: Among patients with COVID-19 infection, men had a significantly higher mortality than did women, and this difference was not completely explained by the higher prevalence of comorbidities in men.

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“…Traditionally, women had higher rates of peri-procedural bleeding and vascular complications with PCI [ 74 ••, 75 •, 76 •], which were strongly associated with higher MACE. The Study of Access Site for Enhancement of Percutaneous Coronary Intervention (SAFE-PCI) demonstrated that radial access site was feasible for women [ 74 ••].…”

Section: Evaluation Of Ihd In Womenmentioning

confidence: 99%

Managing Ischemic Heart Disease in Women: Role of a Women’s Heart Center

Khandelwal

Bakir

Bezaire

et al. 2021

Curr Atheroscler Rep

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Purpose of Review Heart centers for women (HCW) were developed due to the rising cardiovascular morbidity and mortality in women in the United States in the early 1990s. Our review encompasses the epidemiology, risk factors, diagnostic strategies, treatments, and the role of HCW in managing women with ischemic heart disease (IHD). Recent Findings HCW use a multidisciplinary team to manage women with IHD. Due to the paucity of randomized controlled trials investigating various manifestations of IHD, some treatments are not evidence-based such as those for coronary microvascular dysfunction and spontaneous coronary artery dissection. Sex-specific risk factors have been identified and multimodality cardiac imaging is improving in diagnosing IHD in women. Treatments are being studied to help improve symptoms and outcomes in women with IHD. Summary There has been progress in the care of women with IHD. HCW can be instrumental in treating women with IHD, doing research, and being a source of research study participants.

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Incidence and Outcomes of Acute Ischemic Stroke Following Percutaneous Coronary Interventions in Men Versus Women

Cited by 8 publications

References 18 publications

Sex difference in clinical and procedural outcomes in patients undergoing coronary atherectomy: a systematic review and meta-analysis

Sex difference in clinical and procedural outcomes in patients undergoing coronary atherectomy: a systematic review and meta-analysis

Sex Differences in Case Fatality Rate of COVID-19: Insights From a Multinational Registry

Managing Ischemic Heart Disease in Women: Role of a Women’s Heart Center

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