Does sex matter? Thirty-day stroke and death rates after carotid artery stenting in women versus men: results from the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) lead-in phase.
Does sex matter? Thirty-day stroke and death rates after carotid artery stenting in women versus men: results from the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) lead-in phase.
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DOI：
10.1161/strokeaha.108.541847
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发表时间：
2009-04
期刊：
影响因子：
8.3
通讯作者：
Brott TG
中科院分区：
文献类型：
--
作者：
Howard VJ;Voeks JH;Lutsep HL;Mackey A;Milot G;Sam AD 2nd;Tom M;Hughes SE;Sheffet AJ;Longbottom M;Avery JB;Hobson RW 2nd;Brott TG
一些颈动脉内膜切除术（CEA）随机对照试验（rct）和系列报道了女性比男性更高的围手术期卒中和死亡率。在颈动脉血管重建术内膜切除术与支架植入术试验（CREST）的先导阶段，研究了颈动脉支架植入术（CAS）的潜在相同关系。CREST比较了CEA和CAS在围手术期和随访期间预防卒中、心肌梗死和死亡的疗效。CREST包括有症状（狭窄≥50%）和无症状（狭窄≥70%）患者的“引入”期。患者在手术前、24小时和30天由神经科医生检查。对中风和死亡的审查是由一个独立的事件委员会进行的。在1564例CAS患者（26.5%有症状）中，研究了性别与围手术期卒中和死亡的关系。女性占引入队列的37%，在年龄、症状状态或颈内动脉特征方面与男性没有差异。女性30天中风和死亡率为4.5% (26/579)(95% CI: 3.0-6.5%)，而男性为4.2% (41/985)（95% CI: 3.0-5.6%）。卒中和死亡率的差异不显著，在调整年龄、动脉特征或心血管危险因素后，性别之间也没有显著差异。这些结果并没有提供证据表明女性比男性有更高的CAS卒中和死亡率。在CREST的随机化阶段，性别差异的潜在围手术期风险将被前瞻性地解决。
Several carotid endarterectomy (CEA) randomized controlled trials (RCTs) and series have reported higher perioperative stroke and death rates for women compared to men. The potential for this same relationship with carotid artery stenting (CAS) was examined in the lead-in phase of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST). CREST compares efficacy of CEA and CAS in preventing stroke, myocardial infarction, and death in the peri-procedural period and ipsilateral stroke over the follow-up period. CREST included a “lead-in” phase of symptomatic (≥50% stenosis) and asymptomatic (≥70% stenosis) patients. Patients were examined by a neurologist pre-procedure, at 24-hours, and at 30-days. Review of stroke and death was by an independent events committee. The association of sex with peri-procedural stroke and death was examined in 1,564 patients undergoing CAS (26.5% symptomatic.) Women comprised 37% of the lead-in cohort and did not differ from men by age, symptomatic status, or characteristics of the internal carotid artery. The 30-day stroke and death rate for women was 4.5% (26/579) (95% CI: 3.0–6.5%) compared to 4.2% (41/985) (95% CI: 3.0–5.6%) for men. The difference in stroke and death rate was not significant, nor were there any significant differences by sex after adjustment for age, arterial characteristics or cardiovascular risk factors. These results do not provide evidence that women have a higher CAS stroke and death rate compared to men. The potential differential peri-procedural risk by sex will be prospectively addressed in the randomized phase of CREST.