TY - JOUR
T1 - Impact of Gender on Transcatheter Aortic Valve Implantation Outcomes
AU - Stehli, Julia
AU - Dagan, Misha
AU - Zaman, Sarah
AU - Koh, Ji Quan Samuel
AU - Quine, Edward
AU - Gouskova, Natalia
AU - Crawford, Claudia
AU - Dong, Michael
AU - Nanayakkara, Shane
AU - Htun, Nay M.
AU - Stub, Dion
AU - Dick, Ronald
AU - Walton, Antony
AU - Duffy, Stephen J.
N1 - Funding Information:
SJD's work is supported by a National Health and Medical Research Council of Australia grant ( No. 1111170 ). JS is supported by a Monash University scholarship, has received educational grants and holds stock in Medtronic and Abbott. SN is supported by a grant from the National Heart Foundation ( No. 101116 ). SZ is supported by the National Heart Foundation and Monash Partners/MRFF. She has also obtained funding from Abbott Vascular, Biotronik Australia, and Medtronic Australia .
Funding Information:
Conflicts of interest: ASW is proctor for and on the Medical Advisory Board of Medtronic. DS receives a National Heart Foundation Fellowship and Viertel Foundation Award. NMH receives a Royal Australasian College of Physicians Research Establishment Fellowship. SJD is proctor for Medtronic. All other authors have no conflicts of interest.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/10/15
Y1 - 2020/10/15
N2 - Previous studies indicate that women who underwentwho underwent transcatheter aortic valve implantation (TAVI) have poorer 30-day outcomes compared with men. However, the effect of gender as a prognostic factor for long-term outcomes following TAVI remains unclear. Between 2008 and 2018, all patients (n = 683) who underwent TAVI in 2 centres in Melbourne, Australia were prospectively included in a registry. The primary end-point was long-term mortality. The secondary end points were Valve Academic Research Consortium-2 (VARC-2) in-hospital complications and mortality at 30-days and 1-year. Of 683 patients, 328 (48%) were women. Women had a higher mean STS-PROM score (5.2 ± 3.1 vs 4.6 ± 3.5, p < 0.001) but less co-morbidities than men. Women had a significantly higher in-hospital bleeding rates (3.3% vs 1.0%, Odds Ratio 4.21, 95% confidence interval [CI] 1.16 to15.25, p = 0.027) and higher 30-day mortality (2.4% vs 0.3%, hazard ratio [HR] 8.75, 95% CI 1.09 to 69.6, p = 0.040) than men. Other VARC-2 outcomes were similar between genders. Overall mortality rate was 36% (246) over a median follow up of 2.7 (interquartile rang [IQR] 1.7 to 4.2) years. Median time to death was 5.3 (95% CI 4.7 to 5.7) years. One-year mortality was similar between genders (8.3% vs 7.8%), as was long-term mortality (HR = 0.91, 95% CI 0.71 to 1.17, p = 0.38). On multivariable analysis, female gender was an independent predictor for 1-year mortality (HR = 2.33, 95% CI 1.11 to 4.92, p = 0.026), but not long-term mortality (HR = 0.78, 95% CI 0.54 to 1.14, p = 0.20). In the women only cohort, STS-PROM was the only independent predictor of long-term mortality (HR 1.88, 95% CI 1.42 to 2.48, p < 0.001). In conclusion, women had higher rates of peri-procedural major bleeding and 30-day mortality following TAVI. However, long-term outcomes were similar between genders.
AB - Previous studies indicate that women who underwentwho underwent transcatheter aortic valve implantation (TAVI) have poorer 30-day outcomes compared with men. However, the effect of gender as a prognostic factor for long-term outcomes following TAVI remains unclear. Between 2008 and 2018, all patients (n = 683) who underwent TAVI in 2 centres in Melbourne, Australia were prospectively included in a registry. The primary end-point was long-term mortality. The secondary end points were Valve Academic Research Consortium-2 (VARC-2) in-hospital complications and mortality at 30-days and 1-year. Of 683 patients, 328 (48%) were women. Women had a higher mean STS-PROM score (5.2 ± 3.1 vs 4.6 ± 3.5, p < 0.001) but less co-morbidities than men. Women had a significantly higher in-hospital bleeding rates (3.3% vs 1.0%, Odds Ratio 4.21, 95% confidence interval [CI] 1.16 to15.25, p = 0.027) and higher 30-day mortality (2.4% vs 0.3%, hazard ratio [HR] 8.75, 95% CI 1.09 to 69.6, p = 0.040) than men. Other VARC-2 outcomes were similar between genders. Overall mortality rate was 36% (246) over a median follow up of 2.7 (interquartile rang [IQR] 1.7 to 4.2) years. Median time to death was 5.3 (95% CI 4.7 to 5.7) years. One-year mortality was similar between genders (8.3% vs 7.8%), as was long-term mortality (HR = 0.91, 95% CI 0.71 to 1.17, p = 0.38). On multivariable analysis, female gender was an independent predictor for 1-year mortality (HR = 2.33, 95% CI 1.11 to 4.92, p = 0.026), but not long-term mortality (HR = 0.78, 95% CI 0.54 to 1.14, p = 0.20). In the women only cohort, STS-PROM was the only independent predictor of long-term mortality (HR 1.88, 95% CI 1.42 to 2.48, p < 0.001). In conclusion, women had higher rates of peri-procedural major bleeding and 30-day mortality following TAVI. However, long-term outcomes were similar between genders.
UR - http://www.scopus.com/inward/record.url?scp=85089735404&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2020.07.052
DO - 10.1016/j.amjcard.2020.07.052
M3 - Article
C2 - 32843145
AN - SCOPUS:85089735404
SN - 0002-9149
VL - 133
SP - 98
EP - 104
JO - The American Journal of Cardiology
JF - The American Journal of Cardiology
ER -