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The findings suggest that TAVI might be the preferred treatment option for elderly women with symptomatic severe aortic stenosis.
Amsterdam, The Netherlands – Monday 2 September 2013: Women are 25% less likely to die one year after TAVI than men, according to research presented at the ESC Congress today by Dr Mohammad Sherif from Germany. The findings suggest that TAVI might be the preferred treatment option for elderly women with symptomatic severe aortic stenosis.
Dr Sherif said: “Earlier studies on the impact of gender on outcome after transcatheter aortic valve implantation (TAVI) have had conflicting results. A Canadian study reported in 641 consecutive patients that female sex is associated with a better long-term and short-term survival after TAVI.1 An Italian study of 305 high risk patients found no gender differences in composite safety and efficacy endpoints at 30 days and one year after TAVI.”2
The current analysis examined gender differences in outcomes for 1432 consecutive patients from 27 centers who were enrolled in the German TAVI registry between January 2009 and June 2010. Women comprised 57.8% of the cohort. At baseline the average age of women was 83 years vs 80 years for men. Women had aortic valve gradients at baseline of 52 mmHg vs 45 mmHg for men (severe aortic stenosis is defined as gradients exceeding 40 mmHg).At baseline men had more prior myocardial infarction (22% vs 11.5%, p<0.001); more extensive coronary artery disease (36% vs 16%, p<0.001); more history of open-heart surgery (33% vs 14%, p<0.001); more peripheral vascular disease (37% vs 26%, p<0.001); and more COPD (28% vs 21%, p<0.001).During the TAVI procedure, 25.2% of women had vascular complications (including iliac artery dissection, and bleeding from the puncture site requiring blood transfusion) compared to 17.2% of men (p<0.001).At 30 days follow-up mortality was 7.6% for women versus 8.6% for men (p=0.55); however by one year the all cause mortality was 17.3% for women vs 23.6% for men (p<0.01). Dr Sherif said: “Our results show that mortality at 30 days was the nearly same for women and men. Women’s higher survival rate at one year could be explained by their longer life expectancy and lower rates of comorbidity in comparison to men.”The investigators did a multivariate analysis to adjust for the effect of differences between women and men in demographic, procedural, and clinical variables on one year mortality. Figure 1 shows women’s survival advantage at 12 months. Even after adjustment, female gender was an independent predictor for one-year survival after TAVI with a hazard ratio of 0.75.
Dr Sherif said: “This means that women are 25% less likely to die after TAVI than men.Dr Sherif said: “Lower levels of fibrosis in women might explain the more rapid reversal of myocardial hypertrophy after correction of aortic stenosis and might partially explain the better outcome in women compared with men.3 This might account for the time delay in the female advantage, since the reversal process takes longer than 30 days.”He added: “As a limitation for registry data, these data are observational, and therefore can only be considered to be hypothesis generating rather than causative.”Dr Sherif concluded: “Future work should focus on the effect of sex differences in outcomes for intermediate risk patients undergoing TAVI, and provide longer-term follow up for high-risk patients.”
This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2013. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.More information on the ESC Press Conference page: Aortic stenosis, the most common valvular disease
About the European Society of CardiologyThe European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe. About ESC Congress 2013The ESC Congress is currently the world’s premier conference on the science, management and prevention of cardiovascular disease. The spotlight of this year's event is "The Heart Interacting with Systemic Organs". ESC Congress 2013 takes place from 31 August to 4 September at the RAI centre in Amsterdam, Netherlands. More information on ESC Congress 2013 contact the ESC Press Office.
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