Imperial College Healthcare NHS Trust, London, United Kingdom.
Imperial College Healthcare NHS Trust, London, United Kingdom.
Am J Cardiol. 2014 Feb 1;113(3):522-8. doi: 10.1016/j.amjcard.2013.10.024. Epub 2013 Nov 9.
Gender differences exist in outcomes after percutaneous coronary intervention and coronary artery bypass graft surgery but have yet to be fully explored after transcatheter aortic valve implantation. We aimed to investigate gender differences after transcatheter aortic valve implantation in the UK National Institute for Cardiovascular Outcomes Research registry. A retrospective analysis was performed of Medtronic CoreValve and Edwards SAPIEN implantation in 1,627 patients (756 women) from January 2007 to December 2010. Men had more risk factors: poor left ventricular systolic function (11.9% vs 5.5%, p <0.001), 3-vessel disease (19.4% vs 9.2%, p <0.001), previous myocardial infarction (29.5% vs 13.0%, p <0.001), peripheral vascular disease (32.4% vs 23.3%, p <0.001), and higher logistic EuroSCORE (21.8 ± 14.2% vs 21.0 ± 13.4%, p = 0.046). Thirty-day mortality was 6.3% (confidence interval 4.3% to 7.9%) in women and 7.4% (5.6% to 9.2%) in men and at 1 year, 21.9% (18.7% to 25.1%) and 22.4% (19.4% to 25.4%), respectively. There was no mortality difference: p = 0.331 by log-rank test; hazard ratio for women 0.91 (0.75 to 1.10). Procedural success (96.6% in women vs 96.4% in men, p = 0.889) and 30-day cerebrovascular event rates (3.8% vs 3.7%, p = 0.962) did not differ. Women had more major vascular complications (7.5% vs 4.2%, p = 0.004) and less moderate or severe postprocedural aortic regurgitation (7.5% vs 12.5%, p = 0.001). In conclusion, despite a higher risk profile in men, there was no gender-related mortality difference; however, women had more major vascular complications and less postprocedural moderate or severe aortic regurgitation.
性别差异存在于经皮冠状动脉介入治疗和冠状动脉旁路移植术后，但在经导管主动脉瓣植入术后尚未得到充分探讨。我们旨在研究英国国家心血管结果研究注册中心经导管主动脉瓣植入术后的性别差异。对 2007 年 1 月至 2010 年 12 月期间接受美敦力 CoreValve 和爱德华兹 SAPIEN 植入的 1627 例患者（756 例女性）进行了回顾性分析。男性有更多的危险因素：左心室收缩功能不良（11.9%比 5.5%，p<0.001），3 支血管疾病（19.4%比 9.2%，p<0.001），既往心肌梗死（29.5%比 13.0%，p<0.001），外周血管疾病（32.4%比 23.3%，p<0.001），和较高的逻辑 EuroSCORE（21.8±14.2%比 21.0±13.4%，p=0.046）。女性 30 天死亡率为 6.3%（置信区间 4.3%至 7.9%），男性为 7.4%（5.6%至 9.2%），1 年时分别为 21.9%（18.7%至 25.1%）和 22.4%（19.4%至 25.4%）。死亡率无差异：log-rank 检验的 p=0.331；女性的危险比为 0.91（0.75 至 1.10）。手术成功率（女性 96.6%，男性 96.4%，p=0.889）和 30 天脑血管事件发生率（3.8%比 3.7%，p=0.962）无差异。女性有更多的主要血管并发症（7.5%比 4.2%，p=0.004）和较少的中度或重度术后主动脉瓣反流（7.5%比 12.5%，p=0.001）。总之，尽管男性的风险状况较高，但没有性别相关的死亡率差异；然而，女性有更多的主要血管并发症和较少的中度或重度术后主动脉瓣反流。
