Sex Differences in Transfemoral Transcatheter Aortic Valve Replacement

Wieneke Vlastra; Jaya Chandrasekhar; Bruno García Del Blanco; Didier Tchétché; Fabio S de Brito; Marco Barbanti; Ran Kornowski; Azeem Latib; Augusto D'Onofrio; Flavio Ribichini; Jan Baan; Jan G P Tijssen; Raul Moreno; Nicolas Dumonteil; Flavio Tarasoutchi; Samantha Sartori; Paola D'Errigo; Giuseppe Tarantini; Mattia Lunardi; Katia Orvin; Matteo Pagnesi; Alberto Berenguer; Thomas Modine; George Dangas; Roxana Mehran; Jan J Piek

doi:https://doi.org/10.1016/j.jacc.2019.09.015

Sex Differences in Transfemoral Transcatheter Aortic Valve Replacement

Wieneke Vlastra, Jaya Chandrasekhar, Bruno García Del Blanco, Didier Tchétché, Fabio S de Brito, Marco Barbanti, Ran Kornowski, Azeem Latib, Augusto D'Onofrio, Flavio Ribichini, Jan Baan, Jan G P Tijssen, Raul Moreno, Nicolas Dumonteil, Flavio Tarasoutchi, Samantha Sartori, Paola D'Errigo, Giuseppe Tarantini, Mattia Lunardi, Katia OrvinMatteo Pagnesi, Alberto Berenguer, Thomas Modine, George Dangas, Roxana Mehran, Jan J Piek

Research output: Contribution to journal › Article › Academic › peer-review

69 Citations (Scopus)

Abstract

BACKGROUND: Transfemoral aortic valve replacement (TAVR) is a guideline-recommended treatment option for patients with severe aortic valve stenosis. Women and men present with different baseline characteristics, which may influence procedural outcomes.

OBJECTIVES: This study sought to evaluate differences between women and men undergoing transfemoral TAVR across the globe during the last decade.

METHODS: The CENTER (Cerebrovascular EveNts in patients undergoing TranscathetER aortic valve implantation with balloon-expandable valves versus self-expandable valves)-collaboration was a global patient level dataset of patients undergoing transfemoral TAVR (N = 12,381) from 2007 to 2018. In this retrospective analysis, the study examined differences in baseline patient characteristics, 30-day stroke and mortality, and in-hospital outcomes between female and male patients. The study also assessed for temporal changes in outcomes and predictors for mortality per sex.

RESULTS: We included 58% (n = 7,120) female and 42% (n = 5,261) male patients. Women had higher prevalence of hypertension and glomerular filtration rate <30 ml/min/1.73 m2 but lower prevalence of all other traditional cardiovascular comorbidities. Both sexes had similar rates of 30-day stroke (2.3% vs. 2.5%; p = 0.53) and mortality (5.9% vs. 5.5%; p = 0.17). In contrast, women had a 50% higher risk of life-threatening or major bleeding (6.7% vs. 4.4%; p < 0.01). Over the study period, mortality rates decreased to a greater extent in men than in women (60% vs. 50% reduction; both p < 0.001), with no reductions in stroke rates over time.

CONCLUSIONS: In this global collaboration, women and men had similar rates of 30-day mortality and stroke. However, women had higher rates of procedural life-threatening or major bleeding after TAVR. Between 2007 and 2018, mortality rates decreased to a greater extent in men than in women.

Original language	English
Pages (from-to)	2758-2767
Number of pages	10
Journal	Journal of the American College of Cardiology
Volume	74
Issue number	22
DOIs	https://doi.org/10.1016/j.jacc.2019.09.015
Publication status	Published - 3 Dec 2019

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https://doi.org/10.1016/j.jacc.2019.09.015

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Vlastra, W., Chandrasekhar, J., García Del Blanco, B., Tchétché, D., de Brito, F. S., Barbanti, M., Kornowski, R., Latib, A., D'Onofrio, A., Ribichini, F., Baan, J., Tijssen, J. G. P., Moreno, R., Dumonteil, N., Tarasoutchi, F., Sartori, S., D'Errigo, P., Tarantini, G., Lunardi, M., ... Piek, J. J. (2019). Sex Differences in Transfemoral Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology, 74(22), 2758-2767. https://doi.org/10.1016/j.jacc.2019.09.015

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title = "Sex Differences in Transfemoral Transcatheter Aortic Valve Replacement",

abstract = "BACKGROUND: Transfemoral aortic valve replacement (TAVR) is a guideline-recommended treatment option for patients with severe aortic valve stenosis. Women and men present with different baseline characteristics, which may influence procedural outcomes.OBJECTIVES: This study sought to evaluate differences between women and men undergoing transfemoral TAVR across the globe during the last decade.METHODS: The CENTER (Cerebrovascular EveNts in patients undergoing TranscathetER aortic valve implantation with balloon-expandable valves versus self-expandable valves)-collaboration was a global patient level dataset of patients undergoing transfemoral TAVR (N = 12,381) from 2007 to 2018. In this retrospective analysis, the study examined differences in baseline patient characteristics, 30-day stroke and mortality, and in-hospital outcomes between female and male patients. The study also assessed for temporal changes in outcomes and predictors for mortality per sex.RESULTS: We included 58% (n = 7,120) female and 42% (n = 5,261) male patients. Women had higher prevalence of hypertension and glomerular filtration rate <30 ml/min/1.73 m2 but lower prevalence of all other traditional cardiovascular comorbidities. Both sexes had similar rates of 30-day stroke (2.3% vs. 2.5%; p = 0.53) and mortality (5.9% vs. 5.5%; p = 0.17). In contrast, women had a 50% higher risk of life-threatening or major bleeding (6.7% vs. 4.4%; p < 0.01). Over the study period, mortality rates decreased to a greater extent in men than in women (60% vs. 50% reduction; both p < 0.001), with no reductions in stroke rates over time.CONCLUSIONS: In this global collaboration, women and men had similar rates of 30-day mortality and stroke. However, women had higher rates of procedural life-threatening or major bleeding after TAVR. Between 2007 and 2018, mortality rates decreased to a greater extent in men than in women.",

author = "Wieneke Vlastra and Jaya Chandrasekhar and {Garc{\'i}a Del Blanco}, Bruno and Didier Tch{\'e}tch{\'e} and {de Brito}, {Fabio S} and Marco Barbanti and Ran Kornowski and Azeem Latib and Augusto D'Onofrio and Flavio Ribichini and Jan Baan and Tijssen, {Jan G P} and Raul Moreno and Nicolas Dumonteil and Flavio Tarasoutchi and Samantha Sartori and Paola D'Errigo and Giuseppe Tarantini and Mattia Lunardi and Katia Orvin and Matteo Pagnesi and Alberto Berenguer and Thomas Modine and George Dangas and Roxana Mehran and Piek, {Jan J}",

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year = "2019",

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doi = "https://doi.org/10.1016/j.jacc.2019.09.015",

language = "English",

volume = "74",

pages = "2758--2767",

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Vlastra, W, Chandrasekhar, J, García Del Blanco, B, Tchétché, D, de Brito, FS, Barbanti, M, Kornowski, R, Latib, A, D'Onofrio, A, Ribichini, F, Baan, J , Tijssen, JGP, Moreno, R, Dumonteil, N, Tarasoutchi, F, Sartori, S, D'Errigo, P, Tarantini, G, Lunardi, M, Orvin, K, Pagnesi, M, Berenguer, A, Modine, T, Dangas, G, Mehran, R & Piek, JJ 2019, 'Sex Differences in Transfemoral Transcatheter Aortic Valve Replacement', Journal of the American College of Cardiology, vol. 74, no. 22, pp. 2758-2767. https://doi.org/10.1016/j.jacc.2019.09.015

TY - JOUR

T1 - Sex Differences in Transfemoral Transcatheter Aortic Valve Replacement

AU - Vlastra, Wieneke

AU - Chandrasekhar, Jaya

AU - García Del Blanco, Bruno

AU - Tchétché, Didier

AU - de Brito, Fabio S

AU - Barbanti, Marco

AU - Kornowski, Ran

AU - Latib, Azeem

AU - D'Onofrio, Augusto

AU - Ribichini, Flavio

AU - Baan, Jan

AU - Tijssen, Jan G P

AU - Moreno, Raul

AU - Dumonteil, Nicolas

AU - Tarasoutchi, Flavio

AU - Sartori, Samantha

AU - D'Errigo, Paola

AU - Tarantini, Giuseppe

AU - Lunardi, Mattia

AU - Orvin, Katia

AU - Pagnesi, Matteo

AU - Berenguer, Alberto

AU - Modine, Thomas

AU - Dangas, George

AU - Mehran, Roxana

AU - Piek, Jan J

PY - 2019/12/3

Y1 - 2019/12/3

N2 - BACKGROUND: Transfemoral aortic valve replacement (TAVR) is a guideline-recommended treatment option for patients with severe aortic valve stenosis. Women and men present with different baseline characteristics, which may influence procedural outcomes.OBJECTIVES: This study sought to evaluate differences between women and men undergoing transfemoral TAVR across the globe during the last decade.METHODS: The CENTER (Cerebrovascular EveNts in patients undergoing TranscathetER aortic valve implantation with balloon-expandable valves versus self-expandable valves)-collaboration was a global patient level dataset of patients undergoing transfemoral TAVR (N = 12,381) from 2007 to 2018. In this retrospective analysis, the study examined differences in baseline patient characteristics, 30-day stroke and mortality, and in-hospital outcomes between female and male patients. The study also assessed for temporal changes in outcomes and predictors for mortality per sex.RESULTS: We included 58% (n = 7,120) female and 42% (n = 5,261) male patients. Women had higher prevalence of hypertension and glomerular filtration rate <30 ml/min/1.73 m2 but lower prevalence of all other traditional cardiovascular comorbidities. Both sexes had similar rates of 30-day stroke (2.3% vs. 2.5%; p = 0.53) and mortality (5.9% vs. 5.5%; p = 0.17). In contrast, women had a 50% higher risk of life-threatening or major bleeding (6.7% vs. 4.4%; p < 0.01). Over the study period, mortality rates decreased to a greater extent in men than in women (60% vs. 50% reduction; both p < 0.001), with no reductions in stroke rates over time.CONCLUSIONS: In this global collaboration, women and men had similar rates of 30-day mortality and stroke. However, women had higher rates of procedural life-threatening or major bleeding after TAVR. Between 2007 and 2018, mortality rates decreased to a greater extent in men than in women.

AB - BACKGROUND: Transfemoral aortic valve replacement (TAVR) is a guideline-recommended treatment option for patients with severe aortic valve stenosis. Women and men present with different baseline characteristics, which may influence procedural outcomes.OBJECTIVES: This study sought to evaluate differences between women and men undergoing transfemoral TAVR across the globe during the last decade.METHODS: The CENTER (Cerebrovascular EveNts in patients undergoing TranscathetER aortic valve implantation with balloon-expandable valves versus self-expandable valves)-collaboration was a global patient level dataset of patients undergoing transfemoral TAVR (N = 12,381) from 2007 to 2018. In this retrospective analysis, the study examined differences in baseline patient characteristics, 30-day stroke and mortality, and in-hospital outcomes between female and male patients. The study also assessed for temporal changes in outcomes and predictors for mortality per sex.RESULTS: We included 58% (n = 7,120) female and 42% (n = 5,261) male patients. Women had higher prevalence of hypertension and glomerular filtration rate <30 ml/min/1.73 m2 but lower prevalence of all other traditional cardiovascular comorbidities. Both sexes had similar rates of 30-day stroke (2.3% vs. 2.5%; p = 0.53) and mortality (5.9% vs. 5.5%; p = 0.17). In contrast, women had a 50% higher risk of life-threatening or major bleeding (6.7% vs. 4.4%; p < 0.01). Over the study period, mortality rates decreased to a greater extent in men than in women (60% vs. 50% reduction; both p < 0.001), with no reductions in stroke rates over time.CONCLUSIONS: In this global collaboration, women and men had similar rates of 30-day mortality and stroke. However, women had higher rates of procedural life-threatening or major bleeding after TAVR. Between 2007 and 2018, mortality rates decreased to a greater extent in men than in women.

U2 - https://doi.org/10.1016/j.jacc.2019.09.015

DO - https://doi.org/10.1016/j.jacc.2019.09.015

M3 - Article

C2 - 31562908

SN - 0735-1097

VL - 74

SP - 2758

EP - 2767

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 22

ER -