Journal Article

A Gender Based Analysis of Predictors of All Cause Death After Transcatheter Aortic Valve Implantation

Gasparetto, Valeria, Rossi, Marco Luciano, Gaita, Fiorenzo, Barbanti, Marco, Marra, Sebastiano, Nijhoff, Freek, Rinaldi, Mauro, Bedogni, Francesco, Ferrante, Giuseppe, Grasso, Costanza, D'Ascenzo, Fabrizio, Conrotto, Federico, Tarantini, Giuseppe, Napodano, Massimo, Salizzoni, Stefano, Agostoni, Pierfrancesco, Tamburino, Corrado, Biondi Zoccai, Giuseppe, Giordana, Francesca, D'Amico, Maurizio, Presbitero, Patrizia, Stella, Pieter, Brambilla, Nedy, Moretti, Claudio

2014

Overview

The impact of gender-related pathophysiologic features of severe aortic stenosis on transcatheter aortic valve implantation (TAVI) outcomes remains to be determined, as does the consistency of predictors of mortality between the genders. All consecutive patients who underwent TAVI at 6 institutions were enrolled in this study and stratified according to gender. Midterm all-cause mortality was the primary end point, with events at 30 days and at midterm as secondary end points. All events were adjudicated according to Valve Academic Research Consortium definitions. Eight hundred thirty-six patients were enrolled, 464 (55.5%) of whom were female. At midterm follow-up (median 365 days, interquartile range 100 to 516) women had similar rates of all-cause mortality compared with men (18.1% vs 22.6%, p = 0.11) and similar incidence of myocardial infarction and cerebrovascular accident. Gender did not affect mortality also on multivariate analysis. Among clinical and procedural features, glomerular filtration rate <30 ml/min/1.73 m2 (hazard ratio [HR] 2.55, 95% confidence interval [CI] 1.36 to 4.79) and systolic pulmonary arterial pressure >50 mm Hg (HR 2.26, 95% CI 1.26 to 4.02) independently predicted mortality in women, while insulin-treated diabetes (HR 3.45, 95% CI 1.47 to 8.09), previous stroke (HR 3.42, 95% CI 1.43 to 8.18), and an ejection fraction <30% (HR 3.82, 95% CI 1.41 to 10.37) were related to mortality in men. Postprocedural aortic regurgitation was independently related to midterm mortality in the 2 groups (HR 11.19, 95% CI 3.3 to 37.9). In conclusion, women and men had the same life expectancy after TAVI, but different predictors of adverse events stratified by gender were demonstrated. These findings underline the importance of a gender-tailored clinical risk assessment in TAVI patients. •To analyze gender differences in outcomes after TAVI, and to identify gender-dependent predictors of midterm all-cause mortality, a retrospective study was conducted in a large international multicenter TAVI registry.•Baseline and echocardiographic features in female and male patients were different.•Women had similar rates of all-cause mortality compared with men and similar incidence of myocardial infarction and cerebrovascular accident.•Among clinical and procedural features, glomerular filtration rate <30 ml/min/1.73 m2 and systolic pulmonary arterial pressure >50 mm Hg independently predicted mortality in women, while insulin-treated diabetes, previous stroke, and an ejection fraction <30% were related to mortality in men.•Postprocedural aortic regurgitation was independently related to midterm mortality in the 2 groups.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aortic Valve Stenosis - mortality / Aortic Valve Stenosis - surgery / Cardiac Catheterization / Cardiology / Cardiovascular / Cause of Death - trends / Confidence intervals / Female / Follow-Up Studies / Gender / Heart attacks / Heart Valve Prosthesis Implantation - methods / Humans / Incidence / Italy - epidemiology / Male / Medical imaging / Mortality / Netherlands - epidemiology / Postoperative Complications - epidemiology / Prognosis / Retrospective Studies / Risk Assessment - methods / Sex Distribution / Sex Factors / Stroke / Studies / Survival Rate - trends / Time Factors / Tomography / Variables / Women