Autor:innen:
L. Makowski (Münster, DE)
J. Köppe (Muenster, DE)
C. Engelbertz (Muenster, DE)
P. Dröge (Berlin, DE)
T. Ruhnke (Berlin, DE)
C. Günster (Berlin, DE)
J. Gerß (Muenster, DE)
N. Malyar (Muenster, DE)
E. Freisinger (Muenster, DE)
H. Reinecke (Muenster, DE)
J. Feld (Muenster, DE)
Background: The peripheral artery disease (PAD) of the upper extremity is less common and the underlying causes are manifold and classified into degenerative, thromboembolic, inflammatory and functional causes. Knowledge about outcome of patients with upper extremity arterial disease (UEAD) is limited and more knowledge, particularly with focus on sex disparities, are urgently needed.
Patients and methods: The cohort exist of 3,196 unselected patients of the AOK health insurance (“Allgemeine Ortskrankenkasse”), hospitalized between 2010 and 2017 for a main diagnosis of UEAD. The data included a baseline period of 2 years previous index hospitalization and a follow-up (FU) period until 2019, analysing sex related differences in their risk profile, as well as the impact on long-term outcome.
Results: In the cohort of 3,196 patients with UEAD females were in average two years older (median: 67.9 years in females vs. 66.0 years in males) and display the minority (55% male vs. 45% female, both P < 0.001). While females had higher rates of systemic vasculitis (24% vs 18%), males were more often co-diagnosed with cardiovascular risk factors or comorbidities like diabetes mellitus (40% vs. 52%), dyslipidaemia (68% vs. 72%) or smoking (35% vs. 39%) lower extremity artery disease (35% vs. 55%), atrial fibrillation or-flutter (19% vs. 28%), chronic coronary syndrome (41% vs. 56%), chronic heart failure (33% vs. 44%) or chronic kidney disease (37% vs. 50%, all P < 0.001). The prescription rate of guideline recommended drugs like statin or antithrombotic therapy (AT), was partially higher in men during baseline (40% vs. 47% for statin; 32% vs. 44% for AT, both P < 0.001) and two years post index hospitalisation (63% vs. 62%, P = 0.896; 80% vs. 83%, P < 0.001). Two years post index the mortality rate was roughly one quarter (20.5% vs. 32.4%), while almost 10% of the patients underwent an amputation of the upper limb (5.2% vs. 13.5%), both statistically noticeable higher in men (both P < 0.001). After adjustment for age, cardiovascular, systemic vasculitis and vascular procedure in a multivariable Cox regression analysis, female sex was associated with lower mortality rates (Hazard ratio (HR) 0.82, Confidence interval (CI) 0.73-0.93, P-value 0.002) and amputation rates (HR 0.60, CI 0.50-0.71, P < 0.001).
Conclusion: Patients with UEAD have a poor prognosis and male sex was an independent risk factor for all-cause mortality and amputation of the upper extremity during FU. While males suffer more often from typical cardiovascular risk factors and comorbidities, females had lower prescription rates of guideline recommended medications, even after index hospitalisation. Further analyses are needed to determine the various individual needs of male and female UEAD patients.