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Sex-related differences in outcomes after TAVI

Although men had lower risks for major/life-threatening bleeding and major vascular complications after transcatheter aortic valve implantation (TAVI), they had less favourable short-term and midterm survival, according to a study published recently in Circulation: Cardiovascular Interventions.

Authors searched the Cochrane library and PubMed online databases for articles reporting sex-specific post–TAVI complications and mortality. Random- and fixed-effects models were used depending on between-study heterogeneity. There were 27 articles, a total of 9,118 patients, enrolled in our systematic review and meta-analysis, including 4,176 men and 4,942 women. Pooled analyses suggested considerable sex-related differences in complications and early as well as midterm outcomes after TAVI.

The difference in the risk for heart block requiring permanent pacemaker implantation was noted to be significant only in the subgroup of the CoreValve-dominating studies (pooled risk ratio [RR, men versus women], 1.29; 95% confidence interval [CI], 1.13–1.47). Although men had significantly lower risks for major/life-threatening bleeding (pooled RR, 0.81; 95% CI, 0.68–0.96) and major vascular complications (pooled RR, 0.49; 95% CI, 0.37–0.66), they had poorer prognosis. In fact, male sex was associated with significantly higher risks for deaths at both 30 days (RR, 1.37; 95% CI, 1.07–1.76) and 1 year (RR, 1.30; 95% CI, 1.14–1.49).

Speaking to BJC Arrhythmia Watch, co-author Dr Mao Chen (West China Hospital, Sichuan University) said: “It remains to be determined as to the exact mechanisms underlying the phenomenon that men do worse than women after TAVI. Of the several explanations offered in the paper, the higher comorbidity burden in men undergoing TAVI may play a larger part, we think. This was supported by the pooled results of the sex-specific baseline characteristics, available in five of the included studies. Although no significant differences in the mean logistic EuroSCORE were noted, the prevalence rate of coronary artery disease (76.0% vs. 51.8%), previous myocardial infarction (MI) (34.3% vs. 19.5%), chronic obstructive pulmonary disease (38.6% vs. 24.2%), and peripheral vascular disease (33.2% vs. 21.3%) were much higher in men than in women.”

“As these comorbidities could reduce patients’ tolerance to TAVI and take death tolls on follow-up, it seems reasonable that men in general should do worse with TAVI. However, several studies found male gender to independently predict short-term and mid-term mortality after adjusting for these comorbidites. We are not able to perform such an adjusted analysis due to the lack of patient-level data, but we believe that some unknown factors, such as the pathophysiological differences between the two sexes, have played an important role and further studies would help provide valuable insights into this issue,” Dr Chen continued.

References

1. Zhao ZG, Liao YB, Peng Y, et al. Sex-related differences in outcomes after transcatheter aortic valve implantation. Circ Cardiovasc interv 2013;6:543–51. http://dx.doi.org/10.1161/​CIRCINTERVENTIONS.113.000529

Published on: November 20, 2013

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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