Abstract
Background
The disparity in outcomes of cardiac electronic device implantations between sexes
has been previously demonstrated in device-specific cohorts (eg, implantable cardioverter-defibrillators
[ICDs]). However, it is unclear whether sex differences are present with all types
of cardiac implantable electronic devices (CIEDs) and, if so, what the trends of such
differences have been in recent years.
Methods
With the use of the National Inpatient Sample, all hospitalizations from 2004 to 2014
for de novo implantation of permanent pacemakers, cardiac resynchronization therapy with or without
a defibrillator, and ICDs were analyzed to examine the association between sex and
in-hospital acute complications of CIED implantation.
Results
Out of 2,815,613 hospitalizations for de novo CIED implantation, 41.9% were performed on women. Women were associated with increased
adjusted odds (95% confidence interval) of adverse procedural complications (major
adverse cardiovascular complications: 1.17 [1.16-1.19]; bleeding: 1.13 [1.12-1.15],-thoracic:
1.42 [1.40-1.44]; cardiac: 1.44 [1.38-1.50]), whereas the adjusted odds of in-hospital
all-cause mortality compared with men was 0.96 (0.94-1.00). The odds of adverse complications
in the overall CIED cohort were persistently raised in women throughout the study
period, whereas similar odds of all-cause mortality across the sexes were observed
throughout the study period.
Conclusion
In a national cohort of CIED implantations we demonstrate that women are at an overall
higher risk of procedure-related adverse events compared with men, but not at increased
risk of all-cause mortality. Further studies are required to identify procedural techniques
that would improve outcomes among women undergoing such procedures.
Résumé
Contexte
La disparité des résultats de l’implantation d’un dispositif cardiaque électronique
chez les hommes et chez les femmes a déjà été démontrée dans des cohortes de sujets
ayant reçu un dispositif particulier (p. ex. un défibrillateur cardioverteur implantable
[DCI]). On ne sait toutefois pas s’il existe une telle différence entre les hommes
et les femmes pour tous les types de dispositifs cardiaques électroniques implantables
(DCEI) et, s’il y en a une, quelles ont été les tendances à cet égard au cours des
dernières années.
Méthodologie
À l’aide de la base de données NIS (National Inpatient Sample) des États-Unis, nous avons analysé toutes les hospitalisations qui ont eu lieu de
2004 à 2014 pour l’implantation de novo d’un stimulateur cardiaque permanent, un traitement de resynchronisation cardiaque
avec ou sans défibrillateur ou la pose d’un DCI afin de déterminer s’il existe une
association entre le sexe du patient et les complications aiguës liées à l’hospitalisation
pour l’implantation d’un DCEI.
Résultats
Des 2 815 613 patients hospitalisés pour l’implantation de novo d’un DCEI, 41,9 % étaient des femmes. Le fait d’être une femme a été associé à une
hausse de la cote corrigée (intervalle de confiance à 95 %) exprimant le risque de
complications liées à l’intervention (complications cardiovasculaires majeures : 1,17
[de 1,16 à 1,19]; hémorragie : 1,13 [de 1,12 à 1,15]; complications thoraciques :
1,42 [de 1,40 à 1,44]; complications cardiaques : 1,44 [de 1,38 à 1,50]), tandis que
la cote corrigée exprimant le risque de mortalité toutes causes confondues durant
l’hospitalisation chez les femmes comparativement aux hommes était de 0,96 (de 0,94
à 1,00). Le risque de complications dans l’ensemble de la cohorte des patients ayant
reçu un DCEI était systématiquement supérieur chez les femmes durant toute la période
étudiée, tandis que le risque de mortalité toutes causes confondues était comparable
chez les femmes et chez les hommes.
Conclusion
L’analyse d’une cohorte nationale de sujets ayant reçu un DCEI a révélé que les femmes
sont exposées à un risque global de complications liées à l’intervention plus élevé
que les hommes, mais pas à un risque accru de mortalité toutes causes confondues.
D’autres études s’imposent pour déterminer les techniques d’intervention susceptibles
d’améliorer les résultats chez les femmes qui subissent de telles interventions.
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Article info
Publication history
Published online: August 22, 2019
Accepted:
August 5,
2019
Received:
May 21,
2019
Footnotes
See editorial by Humphries and Hawkins, pages 16–18 of this issue.
See page 77 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Sex Differences in Complications and Outcomes of Cardiac Implantable Electronic Devices: Time to Evaluate Our PracticeCanadian Journal of CardiologyVol. 36Issue 1
- PreviewCardiac implantable electronic devices (CIEDs) improve symptoms and quality of life, and reduce death from heart failure or arrhythmias. Approximately 200,000 Canadians are living with one of these devices.1 Although there is overwhelming evidence to support their value, there is evidence of considerable variability in their use, benefits, and adverse outcomes. The study by Mohamed et al.,2 in this edition of the Journal, entitled “Trends in Sex Differences in Outcomes of Cardiac Electronic Device Implantations in the United States,” explores this variability for permanent pacemakers (PPMs), cardiac resynchronization therapy (CRT), and implantable cardioverter defibrillators (ICDs) through the lens of sex differences in a fairly contemporary national cohort.
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