Females are less likely to receive best medical therapy for stroke prevention before and after carotid revascularization than males |
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| Affiliation: | 1. Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD;2. The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;3. Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD;4. Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY;5. Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada;1. R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD;2. Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD;3. Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN;4. Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD;1. Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Medical Institutions, Baltimore, MD;2. Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD;3. Department of Plastics and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD;4. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD;1. Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy;2. Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands;3. Clinical and Community Sciences Department, Università degli Studi di Milano, Milan, Italy;4. Vascular Surgery Unit, ASST Papa Giovanni XXIII, Ospedali di Bergamo, Bergamo, Italy;5. Vascular Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy;1. Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA;2. Division of Vascular Surgery, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI;3. Division of Vascular Surgery, Department of Surgery, Howard University College of Medicine, Washington, DC |
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| Abstract: | BackgroundCurrent professional guidelines recommend best medical therapy (BMT) with statin agents and antiplatelet therapy for primary and secondary stroke prevention in patients with carotid artery stenosis. We aimed to assess the association of patient sex with preoperative BMT in patients undergoing carotid revascularization.MethodsWe performed a retrospective review of Vascular Quality Initiative patients who underwent carotid endarterectomy or carotid artery stenting between January 2003 and February 2022. Multivariable logistic regression models were used to assess the association of patient sex with preoperative BMT after adjusting for sociodemographic, comorbidity, and disease severity characteristics. In-hospital outcomes were assessed by sex and preoperative BMT status.ResultsOf 214,008 patients who underwent carotid revascularization, 38.7% (n = 82,855) were female and 61.3% (n = 131,153) were male. Overall, 77.2% (n = 63,922) of females were on preoperative BMT, compared with 80.4% (n = 105,375) of males (P < .001). After adjusting for baseline differences, females had 11% lower odds of being on BMT compared with males (adjusted odds ratio, 0.89; 95% confidence interval, 0.86-0.91). Postoperatively, females had 18% lower odds of being prescribed BMT than males (adjusted odds ratio, 0.82; 95% confidence interval, 0.79-0.84). In-hospital stroke (1.20% vs 1.51%), death (0.37% vs 0.66%), and stroke/death (1.46% vs 1.98%) were all significantly lower for patients on BMT (all P < .001).ConclusionsThere is a significant discrepancy in the proportion of females versus males receiving preoperative BMT for stroke prevention before carotid artery revascularization. In-hospital outcomes are worse in patients without BMT, highlighting the importance of raising awareness and implementing targeted interventions to improve preoperative adherence to stroke prevention guidelines. |
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| Keywords: | Carotid artery stenosis Stroke guidelines Stroke prevention Medical management Best medical therapy |
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