Women treated with percutaneous thrombectomy face poorer outcomes than men
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Among patients with pulmonary embolism who underwent percutaneous thrombectomy, women experienced more procedure complications and mortality than men, according to study results published in CHEST.
“Overall, considerable sex-based differences were present in the outcomes of patients with pulmonary embolism (PE) who underwent percutaneous pulmonary thrombectomy,” Manyoo A. Agarwal, MD, of the division of cardiovascular medicine at the David Geffen School of Medicine at UCLA, and colleagues wrote. “The explanation for such differences in outcomes for women is not clear, but findings from this study will help to raise awareness and to elucidate potential contributors to the disparity.”
In a retrospective cross-sectional study, Agarwal and colleagues analyzed 5,160 adults with PE who underwent percutaneous pulmonary artery thrombectomy between January 2016 and December 2018 from the Nationwide Inpatient Sample database to find out how outcomes of the procedure differ between sexes.
Researchers assessed demographics and several outcomes, including comorbidities, in-hospital mortality and health care resource use, specifically comparing these outcomes in men and women.
Of the total cohort, 2,520 women (51.8% aged > 65 years; 22.5% Black; 8.1% Hispanic) and 2,640 men (42.2% aged > 65 years; 19.8% Black; 5.5% Hispanic) underwent percutaneous thrombectomy.
Compared with men, women had a higher likelihood of shock (23.4% vs. 15%; P < .01) and acute respiratory failure (53.8% vs. 46.8%; P = .03).
Women who received this procedure also had increased procedural bleeding (16.9% vs. 11.2%; P < .05), needed more blood transfusions (11.9% vs. 5.7%; P < .05) and had more vascular complications (5% vs. 1.5%; P < .05) than men.
In terms of safety outcomes, 16.9% of women died in-hospital, a total higher than that of men at 9.3% (adjusted OR = 1.9; 95% CI, 1.2-3; P = .003).
Further, researchers found that women also had a lower likelihood of being discharged than men (47.9% vs. 60.3%; aOR = 0.7; 95% CI, 0.5-0.99; P = .04) but comparable length of stay and hospital charges.
Looking at the use of health care resources, such as nursing homes and related facilities, women showed more usage than men, according to researchers.
“Our data suggest that female patients undergoing percutaneous pulmonary artery thrombectomy represent a particularly vulnerable patient population,” Agarwal and colleagues wrote. “Further studies are needed to validate our findings and to determine the causes of the increased adverse events and health-care resource use that we observed in this cohort of patients with PE undergoing percutaneous thrombectomy. Efforts then can be directed toward decreasing these events and optimizing health-care resource use.”
This study by Agarwal and colleagues contributes to previous literature that found women with acute PE have poorer outcomes than men; however, more research is needed to figure out the source of these sex disparities, according to an accompanying editorial by Farbod N. Rahaghi, MD, PhD, assistant professor of medicine at Brigham and Women’s Hospital, and colleagues.
“A range of factors, including delayed referral, greater number of comorbidities, advanced illness, older age at presentation, differences in the utility of prognostication tools, differential technical success and complications associated with the procedure, could potentially contribute to an observed difference in sex-related outcomes when using catheter-base thrombectomy for acute PE,” Rahaghi and colleagues wrote.
“Prospective studies such as SERIOUS-PE13 are necessary to better delineate the factors contributing to these differences in outcomes so that solutions can be proposed,” they added. “Understanding the source of these disparate outcomes provides an opportunity to identify targets for improving individual patient outcomes as well as a better understanding of health care delivery to population groups.”