Sex-Related Differences in Clinical Presentation and Outcome of Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis
Sex-Related Differences in Clinical Presentation and Outcome of Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis
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DOI：
10.1016/j.jacc.2011.10.877
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发表时间：
2012-02-07
影响因子：
24
通讯作者：
Lefevre, Thierry
中科院分区：
文献类型：
--
作者：
Hayashida, Kentaro;Morice, Marie-Claude;Lefevre, Thierry
目的探讨性别差异对高危重度主动脉瓣狭窄患者经导管主动脉瓣置入术(TAVI)的影响。背景：尽管TAVI技术日趋成熟，但性别差异的影响尚不清楚。女性比例(n=131)与男性比例(n=129)相似。Edwards瓣膜(85.4%)和CoreValve(14.6%)通过股动脉(65.0%)、锁骨下动脉(3.1%)或心尖动脉(31.9%)入路使用。结果年龄相似(83.1+/-6.3岁)，但女性冠状动脉和外周疾病较少，心脏手术史较少，射血分数较高，EuroSCORE较低(欧洲心脏手术风险评估系统[22.3+/-9.0%vs.26.2+/-13.0%，p=0.005])。女性患者股骨最小直径(7.74±-1.03 mm vs.8.55±1.34 mm，p<；0.001)、瓣环大小(20.9±/-1.4vs.22.9±-1.7 mm，p<；0.001)和瓣膜大小(23.9±/-1.6 mm vs.26.3±/-1.5 mm，p<；0.001)较小。装置成功率相似(90.8%vs.88.4%，p=0.516)，尽管更常见的髂骨并发症(9.0%vs.2.5%，p=0.030)。残余平均主动脉压差(11.6±-4.9vs.10.9+/-4.9，p=0.279)也相似。女性1年生存率为76%(95%可信区间：72%~80%)，高于男性的65%(95%可信区间：60%~69%)。COX回归分析显示，男性(危险比：1.62，95%可信区间：1.03~2.53，p=0.037)是中期死亡的预测因素。(J Am Coll心脏ol 2012；59：566-71)(C)2012，美国心脏病学会基金会
Objectives The purpose of this study was to clarify the impact of sex-related differences in transcatheter aortic valve implantation (TAVI) for high-risk patients with severe aortic stenosis.Background Although TAVI is becoming a mature technique, the impact of sex differences remains unclear.Methods The TAVI patients were included prospectively in a dedicated database from October 2006. The proportion of women (n = 131) was similar to that of men (n = 129). The Edwards valve (85.4%) and CoreValve (14.6%) were used through the transfemoral (65.0%), subclavian (3.1%), or transapical (31.9%) approach. All events were defined according to Valve Academic Research Consortium criteria.Results Age was similar (83.1 +/- 6.3 years), but women had less coronary and peripheral disease, less previous cardiac surgery, higher ejection fraction, and lower EuroSCORE (European System for Cardiac Operative Risk Evaluation [22.3 +/- 9.0% vs. 26.2 +/- 13.0%, p = 0.005]). Minimal femoral size (7.74 +/- 1.03 mm vs. 8.55 +/- 1.34 mm, p < 0.001), annulus size (20.9 +/- 1.4 vs. 22.9 +/- 1.7 mm, p < 0.001), and valve size (23.9 +/- 1.6 mm vs. 26.3 +/- 1.5 mm, p < 0.001) were smaller in women. Device success was similar (90.8% vs. 88.4%, p = 0.516) despite more frequent iliac complications (9.0% vs. 2.5%, p = 0.030). Residual mean aortic pressure gradient (11.6 +/- 4.9 vs. 10.9 +/- 4.9, p = 0.279) was also similar. The 1-year survival rate was higher for women, 76% (95% confidence interval: 72% to 80%), than for men, 65% (95% confidence interval: 60% to 69%); and male sex (hazard ratio: 1.62, 95% confidence interval: 1.03 to 2.53, p = 0.037) was identified as a predictor of midterm mortality by Cox regression analysis.Conclusions Female sex is associated with better baseline clinical characteristics and improved survival, and is identified as a predictor of midterm survival after TAVI. (J Am Coll Cardiol 2012;59:566-71) (C) 2012 by the American College of Cardiology Foundation