Author/Authors :
Conrotto، نويسنده , , Federico and DʹAscenzo، نويسنده , , Fabrizio and Salizzoni، نويسنده , , Stefano and Presbitero، نويسنده , , Patrizia and Agostoni، نويسنده , , Pierfrancesco and Tamburino، نويسنده , , Corrado and Tarantini، نويسنده , , Giuseppe and Bedogni، نويسنده , , Francesco and Nijhoff، نويسنده , , Freek and Gasparetto، نويسنده , , Valeria and Napodano، نويسنده , , Massimo and Ferrante، نويسنده , , Giuseppe De Rossi، نويسنده , , Marco Luciano and Stella، نويسنده , , Pieter and Brambilla، نويسنده , , Nedy and Barbanti، نويسنده , , Marco and Giordana، نويسنده , , Francesca and Grasso، نويسنده , , Costanza and Biondi Zoccai، نويسنده , , Giuseppe and Moretti، نويسنده , , Claudio and DʹAmico، نويسنده , , Maurizio and Rinaldi، نويسنده , , Mauro and Gaita، نويسنده , , Fiorenzo and Marra، نويسنده , , Sebastiano، نويسنده ,
Abstract :
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.