Elsevier

The American Journal of Cardiology

Volume 154, 1 September 2021, Pages 67-77
The American Journal of Cardiology

Outcomes Following Aortic Stenosis Treatment (Transcatheter vs Surgical Replacement) in Women vs Men (From a Nationwide Analysis)

https://doi.org/10.1016/j.amjcard.2021.05.046Get rights and content

Gender-differences in survival following transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) have been suggested. The objective of this study was to analyze outcomes following TAVR according to gender and to compare outcomes between TAVR and SAVR in women, at a nationwide level. Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients treated with TAVR and SAVR between 2010 and 2019. Outcomes were analyzed according to gender and propensity score matching was used for the analysis of outcomes. In total 71,794 patients were identified in the database. After matching on baseline characteristics, we analyzed 12,336 women and 12,336 men treated with TAVR. In a second matched analysis, we compared 9,297 women treated with TAVR and 9,297 women treated with SAVR. Long term follow-up showed lower risk of all-cause death (12.7% vs 14.8%, hazard ratio (HR) 0.85, 95% CI 0.81 to 0.90) in women than men. Although the difference in cardiovascular death remained non-significant (5.8% vs 6.0%, HR 0.96, 95% CI 0.88 to 1.05), non-cardiovascular death was less frequent in women than in men following TAVR (6.9% vs 8.8% HR 0.78, 95%CI 0.72 to 0.84).When TAVR was compared with SAVR in women, long-term follow-up with TAVR showed higher rates of all-cause death (11.2% vs 6.5%, HR 1.91, 95%CI 1.78 to 2.05), cardiovascular death (5.0% vs 3.2%, HR 1.44, 95%CI 1.30 to 1.59), and non-cardiovascular death (6.2% vs 3.3%, HR 2.48, 95% CI 2.25 to 2.72). In conclusion, we observed that women undergoing TAVR have lower long-term all-cause mortality as compared with TAVR in men, driven by non-cardiovascular mortality. SAVR was associated with lower rates of long-term cardiovascular adverse events in women as compared with TAVR.

Section snippets

Methods

This longitudinal cohort study was based on the national hospitalization database covering hospital care from the entire French population, which have been previously described.8 The data for all patients admitted with aortic stenosis in France from January 2010 to June 2019 were collected from the national administrative PMSI database, which was inspired by the US Medicare system. Through this program, which was implemented in 2004, medical activity is recorded in a database, computed, and

Results

Between January 1, 2010, and June 30, 2019, 71,794 patients were identified in the database, including 22,380 female patients treated with TAVR, 21,414 men treated with TAVR, and 28,000 female patients treated with SAVR.

In the unmatched population of women and men who underwent a TAVR women were older, had lower estimated EuroSCORE II and cardiovascular risk factors and had less often a history of coronary artery disease or revascularization (Table 1). In the unmatched population of female

Discussion

In this propensity score-matched analysis, we observed that: Gender had no impact on long-term cardiovascular outcomes after TAVR. We observed lower rates of all-cause death during follow-up in women, this difference being driven by lower incidences of non-cardiovascular death, while cardiovascular mortality was not different. TAVR was associated with better short-term outcomes versus SAVR in women, while after 2 years follow-up, curves tended to cross, and rates of cardiovascular mortality,

Declaration of Competing interests

The authors declare the following financial interests/personal relations which may be considered as potential competing interests: CSE reports honoraria from Abbott and Biotronik. LF reports consultant or speaker activities for Bayer, BMS/Pfizer, Boehringer Ingelheim, Medtronic, and Novartis. TB reports consultant activities for Edwards Lifesciences. AB (Anne Bernard) reports consulting or speaker activities for BMS/Pfizer and Abbott. TC reports consulting or speaker activities for Edwards,

Acknowledgments

None.

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    • Sex, Antithrombotics, and Outcomes After TAVR: Is There More Difference Within Sexes or Between Them?

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    Funding: None.

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