Journal Article

Influence of Gender on Clinical Outcomes Following Transcatheter Aortic Valve Implantation from the UK Transcatheter Aortic Valve Implantation Registry and the National Institute for Cardiovascular Outcomes Research

Davies, Justin E., Blackman, Daniel J., Anderson, Jonathan, Ludman, Peter F., Francis, Darrel P., Moat, Neil, Bicknell, Colin, Mikhail, Ghada W., Malik, Iqbal S., Mayet, Jamil, Cousins, Jonathan, Unsworth, Beth, Sutaria, Nilesh, Al-Lamee, Rasha, Parker, Jessica, Broyd, Christopher, Ariff, Ben, Chukwuemeka, Andrew

2014

Overview

Gender differences exist in outcomes after percutaneous coronary intervention and coronary artery bypass graft surgery but have yet to be fully explored after transcatheter aortic valve implantation. We aimed to investigate gender differences after transcatheter aortic valve implantation in the UK National Institute for Cardiovascular Outcomes Research registry. A retrospective analysis was performed of Medtronic CoreValve and Edwards SAPIEN implantation in 1,627 patients (756 women) from January 2007 to December 2010. Men had more risk factors: poor left ventricular systolic function (11.9% vs 5.5%, p <0.001), 3-vessel disease (19.4% vs 9.2%, p <0.001), previous myocardial infarction (29.5% vs 13.0%, p <0.001), peripheral vascular disease (32.4% vs 23.3%, p <0.001), and higher logistic EuroSCORE (21.8 ± 14.2% vs 21.0 ± 13.4%, p = 0.046). Thirty-day mortality was 6.3% (confidence interval 4.3% to 7.9%) in women and 7.4% (5.6% to 9.2%) in men and at 1 year, 21.9% (18.7% to 25.1%) and 22.4% (19.4% to 25.4%), respectively. There was no mortality difference: p = 0.331 by log-rank test; hazard ratio for women 0.91 (0.75 to 1.10). Procedural success (96.6% in women vs 96.4% in men, p = 0.889) and 30-day cerebrovascular event rates (3.8% vs 3.7%, p = 0.962) did not differ. Women had more major vascular complications (7.5% vs 4.2%, p = 0.004) and less moderate or severe postprocedural aortic regurgitation (7.5% vs 12.5%, p = 0.001). In conclusion, despite a higher risk profile in men, there was no gender-related mortality difference; however, women had more major vascular complications and less postprocedural moderate or severe aortic regurgitation.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged, 80 and over / Aortic Valve - surgery / Aortic Valve Stenosis - surgery / Cardiac Catheterization / Cardiology / Cardiovascular / Cause of Death - trends / Coronary vessels / Female / Follow-Up Studies / Gender differences / Heart attacks / Heart Valve Prosthesis Implantation - methods / Humans / Incidence / Male / Mortality / Postoperative Complications - epidemiology / Registries / Retrospective Studies / Sex Distribution / Sex Factors / Survival Rate - trends / Treatment Outcome / United Kingdom - epidemiology