Impact of Sex Differences on Outcomes of Peripheral Artery Disease Intervention (From a Nationwide Sample)

Abdalla Hassan
Ashraf Abugroun
Hussein Daoud, Advocate Aurora Health
Shafaq Mahmoud
Saria Awadalla
Annabelle Volgman
Alvaro Alonso

Department of Internal Medicine, Advocate Illinois Masonic Medical Center


We aimed to evaluate the role of sex differences in the outcomes of catheter-based peripheral arterial disease (PAD) interventions on a national level. We queried the National Inpatient Sample Database and identified all patients who presented with acute or symptomatic chronic limb ischemia (CLI) requiring transcatheter non-surgical peripheral intervention in the years of 2016 - 2017. The primary outcome was major adverse cardiovascular events (MACE), defined as the composite endpoint of in-hospital mortality, non-fatal stroke, and acute myocardial infarction. Secondary outcomes were the individual components of the primary endpoint, vascular complications, major bleeding, acute kidney injury, limb amputation, total cost, and length of stay. A total of 58,165 patients were included. The majority were males (57.2%) and of white race (67.1%). On multivariate analysis, female sex was an independent predictor of MACE with an adjusted odd ratio (a-OR) of 1.36 (95% CI: 1.12 - 1.65, p = 0.002), mortality (a-OR 1.52; 95% CI: 1.12 - 2.04, p = 0.006), non-fatal stroke (a-OR 2.51; 95% CI: 1.56 - 4.03, p < 0.001), major bleeding (a-OR 1.87; 95% CI: 1.53 - 2.28, p < 0.001), and higher cost with an adjusted mean ratio (a-MR) of 1.03 (95% CI: 1.00 -1.06, p = 0.033). There was no significant difference in the rates of myocardial infarction, vascular complications, limb amputation, acute kidney injury, and length of stay. In conclusion, females presenting with acute or symptomatic CLI requiring transcatheter peripheral intervention have a significantly higher composite risk of MACE.