Angiographic predictors of vascular complications among women undergoing cardiac catheterization and intervention.
BACKGROUND
Bleeding and vascular complications remain more common in women than men undergoing invasive cardiovascular procedures. We determined the role of femoral angiographic variables in risk-stratifying women for vascular complications.


METHODS
Between 2004-2009, all major bleeding and vascular complications among women undergoing diagnostic or interventional cardiovascular procedures were identified at a single center. Thirty consecutive female patients (major bleeding or vascular complication) were then age- and procedure-matched to 90 controls (no vascular complications). Quantitative femoral angiography was performed on all cases and controls.


RESULTS
Smaller minimum luminal diameter was a strong univariate predictor of vascular complications in women (odds ratio [OR] 0.65; 95% confidence interval [CI] 0.47-0.90; p = 0.009), while site of arteriotomy was not predictive of complications. The prognostic significance of smaller femoral lumen diameter was mildly attenuated after adjusting for the predictive factor of smaller patient body size, even after adjusting for the predictive factor of smaller patient body size. Finally, multivariable modeling suggests that utilization of vascular closure devices (OR 0.26, 95% CI 0.07-0.96; p = 0.04) may be protective in women.


CONCLUSIONS
Women with smaller femoral arteries are at significantly higher risk for bleeding and vascular complications than women with larger femoral arteries. Risk stratification for bleeding complications among women should account for clinical, pharmacologic and femoral angiographic factors.
Division of Cardiology, McClure 1, University of Vermont Fletcher Allen Health Care, 111 Colchester Avenue, Burlington VT 05401, USA.
Bina
B
Ahmed
Stefan
S
Lischke
Leigh Ann
LA
Holterman
Faye
F
Straight
Harold L
HL
Dauerman
D000368:Aged; D000792:Angiography; D006328:Cardiac Catheterization / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D005263:Femoral Artery / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D009929:Organ Size; D018570:Risk Assessment; D012307:Risk Factors