Key result
Male sex linked to ~25% higher 5-year mortality after carotid intervention, despite fewer cerebrovascular events.
Why the study?
The impact of sex on outcomes following carotid endarterectomy and carotid artery stenting was not fully elucidated.
Does sex impact the risk of mortality and stroke/TIA in asymptomatic patients following primary carotid interventions?
Observational (n=122,379)
Yes
Does sex impact the risk of mortality and stroke/TIA in asymptomatic patients following primary carotid interventions?
Odds Ratio: 1.25 (95% CI 1.18–1.31)
In asymptomatic patients discharged alive without peri-operative neurologic events after primary carotid intervention, there were no sex differences in 30-day outcomes, but male sex was associated with higher long-term mortality and lower long-term stroke/TIA risks.
Observational data associate male sex with higher long-term mortality but lower stroke/TIA risk after asymptomatic carotid intervention; leaves open need for prospective validation.
Objective: The impact of sex on outcomes following carotid endarterectomy (CEA) and carotid artery stenting (CAS) is not fully elucidated. The aim of this study was to analyze the association between sex and outcomes of asymptomatic patients who underwent primary carotid interventions in France. Methods: This nationwide retrospective study was performed using the French National Health Insurance Information System and included asymptomatic patients who underwent primary carotid intervention over a 10-year period (1 January 2013 to 31 August 2023). Symptomatic patients and patients who had peri-operative neurologic events were excluded. The primary endpoints were the occurrence of death and stroke/transient ischaemic attack (TIA) at 30 days, 1 and 5 years after patients’ discharge. Results: In total, 115,879 patients were admitted for an index CEA (29.4% women) and 6500 for CAS (29.8% women). In the CEA group, no significant sex-related difference was observed for 30-day mortality; however, women had significantly lower 1-year and 5-year mortality rates compared to men (1.9% vs. 2.6%, p < 0.001 and 7.9% vs. 11.1%, p < 0.001). In the CAS group, women had lower 30-day, 1-year and 5-year mortality (0.6% vs. 1.0%, p = 0.040, 3.8% vs. 4.9%, p = 0.048, and 10.4% vs. 15.0%, p < 0.001). A multivariate analysis showed that sex was not associated with the risk of stroke/TIA and mortality at 30 days (OR 0.84 (95% CI 0.67–1.04) and 1.27 (95% CI 0.98–1.64)). Male sex was associated with a higher risk of 1-year and 5-year mortality (OR 1.24 (95% CI 1.13–1.36) and 1.25 (95% CI 1.18–1.31)), but a lower risk of stroke/TIA than female sex. Conclusions: No significant sex-related difference was observed at 30 days in patients being discharged alive and without peri-operative neurologic events. Male sex was associated with a higher risk of mortality but a lower risk of stroke/TIA at 1 and 5 years.
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Lareyre et al. (2024) conducted an observational in Asymptomatic carotid artery disease (n=122,379). Male sex vs. Female sex was evaluated on 5-year mortality (OR 1.25, 95% CI 1.18-1.31). Male sex was associated with a higher risk of 5-year mortality, but a lower risk of stroke or TIA compared to female sex in asymptomatic patients following primary carotid intervention.
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