Conrotto Federico, D'Ascenzo Fabrizio, Salizzoni Stefano, Presbitero Patrizia, Agostoni Pierfrancesco, Tamburino Corrado, Tarantini Giuseppe, Bedogni Francesco, Nijhoff Freek, Gasparetto Valeria, Napodano Massimo, Ferrante Giuseppe, Rossi Marco Luciano, Stella Pieter, Brambilla Nedy, Barbanti Marco, Giordana Francesca, Grasso Costanza, Biondi Zoccai Giuseppe, Moretti Claudio, D'Amico Maurizio, Rinaldi Mauro, Gaita Fiorenzo, Marra Sebastiano
Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
Division of Cardiology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
Am J Cardiol. 2014 Oct 15;114(8):1269-74. doi: 10.1016/j.amjcard.2014.07.053. Epub 2014 Jul 31.
The impact of gender-related pathophysiologic features of severe aortic stenosis on transcatheter aortic valve implantation (TAVI) outcomes remains to be determined, as does the consistency of predictors of mortality between the genders. All consecutive patients who underwent TAVI at 6 institutions were enrolled in this study and stratified according to gender. Midterm all-cause mortality was the primary end point, with events at 30 days and at midterm as secondary end points. All events were adjudicated according to Valve Academic Research Consortium definitions. Eight hundred thirty-six patients were enrolled, 464 (55.5%) of whom were female. At midterm follow-up (median 365 days, interquartile range 100 to 516) women had similar rates of all-cause mortality compared with men (18.1% vs 22.6%, p = 0.11) and similar incidence of myocardial infarction and cerebrovascular accident. Gender did not affect mortality also on multivariate analysis. Among clinical and procedural features, glomerular filtration rate <30 ml/min/1.73 m(2) (hazard ratio [HR] 2.55, 95% confidence interval [CI] 1.36 to 4.79) and systolic pulmonary arterial pressure >50 mm Hg (HR 2.26, 95% CI 1.26 to 4.02) independently predicted mortality in women, while insulin-treated diabetes (HR 3.45, 95% CI 1.47 to 8.09), previous stroke (HR 3.42, 95% CI 1.43 to 8.18), and an ejection fraction <30% (HR 3.82, 95% CI 1.41 to 10.37) were related to mortality in men. Postprocedural aortic regurgitation was independently related to midterm mortality in the 2 groups (HR 11.19, 95% CI 3.3 to 37.9). In conclusion, women and men had the same life expectancy after TAVI, but different predictors of adverse events stratified by gender were demonstrated. These findings underline the importance of a gender-tailored clinical risk assessment in TAVI patients.
严重主动脉瓣狭窄的性别相关病理生理特征对经导管主动脉瓣植入术（TAVI）预后的影响以及两性之间死亡率预测指标的一致性仍有待确定。在6家机构接受TAVI的所有连续患者均纳入本研究，并根据性别进行分层。中期全因死亡率是主要终点，30天和中期的事件作为次要终点。所有事件均根据瓣膜学术研究联盟的定义进行判定。共纳入836例患者，其中464例（55.5%）为女性。在中期随访（中位时间365天，四分位间距100至516天）时，女性与男性的全因死亡率相似（18.1%对22.6%，p = 0.11），心肌梗死和脑血管意外发生率也相似。在多变量分析中，性别也不影响死亡率。在临床和手术特征中，肾小球滤过率<30 ml/min/1.73 m²（风险比[HR] 2.55，95%置信区间[CI] 1.36至4.79）和收缩期肺动脉压>50 mmHg（HR 2.26，95% CI 1.26至4.02）可独立预测女性死亡率，而胰岛素治疗的糖尿病（HR 3.45，95% CI 1.47至8.09）、既往卒中（HR 3.42，95% CI 1.43至8.18）和射血分数<30%（HR 3.82，95% CI 1.41至10.37）与男性死亡率相关。术后主动脉瓣反流与两组的中期死亡率独立相关（HR 11.19，95% CI 3.3至37.9）。总之，TAVI术后女性和男性的预期寿命相同，但显示出按性别分层的不良事件预测指标不同。这些发现强调了对TAVI患者进行针对性别调整的临床风险评估的重要性。
