TY - JOUR
T1 - Long-Term Outcomes With Transcatheter Aortic Valve Replacement in Women Compared With Men
T2 - Evidence From a Meta-Analysis
AU - Saad, Marwan
AU - Nairooz, Ramez
AU - Pothineni, Naga Venkata K.
AU - Almomani, Ahmed
AU - Kovelamudi, Swathi
AU - Sardar, Partha
AU - Katz, Marcelo
AU - Abdel-Wahab, Mohamed
AU - Bangalore, Sripal
AU - Kleiman, Neal S.
AU - Block, Peter C.
AU - Abbott, J. Dawn
N1 - Funding Information:
Dr. Abdel-Wahab is a proctor for Boston Scientific; has received institutional research grants from Biotronik and St. Jude Medical; and has received speaker fees from Medtronic and Edwards Lifesciences. Dr. Abbott is a research consultant for Pfizer and Recor. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2018 American College of Cardiology Foundation
PY - 2018/1/8
Y1 - 2018/1/8
N2 - Objectives This study sought to examine long-term outcomes with transcatheter aortic valve replacement (TAVR) in women versus men. Background TAVR is commonly performed in women. Previous studies have shown conflicting results with respect to sex differences in outcomes with TAVR. In addition, short-term outcomes have primarily been reported. Methods Electronic search was performed until March 2017 for studies reporting outcomes with TAVR in women versus men. Random effects DerSimonian-Laird risk ratios were calculated. Outcomes included all-cause mortality and major cardiovascular events at short- (30 days) and long-term (>1 year) follow-up. Results Seventeen studies (8 TAVR registries; 47,188 patients; 49.4% women) were analyzed. Women were older but exhibited fewer comorbidities. At 30 days, women had more bleeding (p < 0.001), vascular complications (p < 0.001), and stroke/transient ischemic attack (p = 0.02), without difference in all-cause (p = 0.19) or cardiovascular mortality (p = 0.91) compared with men. However, female sex was associated with lower all-cause mortality at 1 year (risk ratio: 0.85; 95% confidence interval: 0.79 to 0.91; p < 0.001), and longest available follow-up (mean 3.28 ± 1.04 years; risk ratio: 0.86; 95% confidence interval: 0.81 to 0.92; p < 0.001), potentially caused by less moderate/severe aortic insufficiency (p = 0.001), and lower cardiovascular mortality (p = 0.009). The female survival advantage remained consistent across multiple secondary analyses. The risk of stroke, moderate/severe aortic insufficiency, and all-cause mortality seemed to vary based on the type of valve used; however, without significant subgroup interactions. Conclusions Despite a higher upfront risk of complications, women derive a better long-term survival after TAVR compared with men.
AB - Objectives This study sought to examine long-term outcomes with transcatheter aortic valve replacement (TAVR) in women versus men. Background TAVR is commonly performed in women. Previous studies have shown conflicting results with respect to sex differences in outcomes with TAVR. In addition, short-term outcomes have primarily been reported. Methods Electronic search was performed until March 2017 for studies reporting outcomes with TAVR in women versus men. Random effects DerSimonian-Laird risk ratios were calculated. Outcomes included all-cause mortality and major cardiovascular events at short- (30 days) and long-term (>1 year) follow-up. Results Seventeen studies (8 TAVR registries; 47,188 patients; 49.4% women) were analyzed. Women were older but exhibited fewer comorbidities. At 30 days, women had more bleeding (p < 0.001), vascular complications (p < 0.001), and stroke/transient ischemic attack (p = 0.02), without difference in all-cause (p = 0.19) or cardiovascular mortality (p = 0.91) compared with men. However, female sex was associated with lower all-cause mortality at 1 year (risk ratio: 0.85; 95% confidence interval: 0.79 to 0.91; p < 0.001), and longest available follow-up (mean 3.28 ± 1.04 years; risk ratio: 0.86; 95% confidence interval: 0.81 to 0.92; p < 0.001), potentially caused by less moderate/severe aortic insufficiency (p = 0.001), and lower cardiovascular mortality (p = 0.009). The female survival advantage remained consistent across multiple secondary analyses. The risk of stroke, moderate/severe aortic insufficiency, and all-cause mortality seemed to vary based on the type of valve used; however, without significant subgroup interactions. Conclusions Despite a higher upfront risk of complications, women derive a better long-term survival after TAVR compared with men.
KW - TAVR
KW - aortic valve replacement
KW - men
KW - sex
KW - women
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U2 - 10.1016/j.jcin.2017.08.015
DO - 10.1016/j.jcin.2017.08.015
M3 - Article
C2 - 29055767
AN - SCOPUS:85031766397
SN - 1936-8798
VL - 11
SP - 24
EP - 35
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 1
ER -