Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK.
Int J Cardiol. 2018 Jan 1;250:66-72. doi: 10.1016/j.ijcard.2017.05.047.
Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is the first area of interventional cardiology where women are treated as often as men. In this analysis of the gender specific results of randomised controlled trials (RCTs) comparing TAVI with surgical aortic valve replacement (SAVR) we aimed to determine whether gender affects the survival comparison between TAVI and SAVR. We identified all RCTs comparing TAVI versus SAVR for severe AS and reporting 1 and/or 2year survival. Summary odds ratios (ORs) were obtained using a random-effects model. Heterogeneity was assessed using the Q statistic and I. Four RCTs met the criteria, totalling 3758 patients, 1706 women and 2052 men. Amongst females, TAVI recipients had a significantly lower mortality than SAVR recipients, at 1year (OR 0.68; 95%CI 0.50 to 0.94) and at 2years (OR 0.74; 95%CI 0.58 to 0.95). Amongst males there was no difference in mortality between TAVI and SAVR, at 1year (OR 1.09; 95%CI 0.86 to 1.39) or 2years (OR 1.05; 95%CI 0.85 to 1.3). The difference in treatment effect between genders was significant at both 1year (p=0.02) and 2years (p=0.04). In women TAVI has a 26 to 31% lower mortality odds than SAVR. In men, there is no difference in mortality between TAVI and SAVR.
经导管主动脉瓣植入术（TAVI）治疗严重主动脉瓣狭窄（AS）是介入心脏病学中第一个女性接受治疗的比例与男性相当的领域。在这项比较 TAVI 与外科主动脉瓣置换术（SAVR）的随机对照试验（RCT）的性别特异性结果分析中，我们旨在确定性别是否影响 TAVI 和 SAVR 之间的生存比较。我们确定了所有比较 TAVI 与 SAVR 治疗严重 AS 并报告 1 年和/或 2 年生存率的 RCT。使用随机效应模型获得汇总优势比（OR）。使用 Q 统计量和 I 评估异质性。四项 RCT 符合标准，共有 3758 名患者，1706 名女性和 2052 名男性。在女性中，TAVI 组患者的死亡率明显低于 SAVR 组，1 年时（OR 0.68；95%CI 0.50 至 0.94）和 2 年时（OR 0.74；95%CI 0.58 至 0.95）。在男性中，1 年时（OR 1.09；95%CI 0.86 至 1.39）和 2 年时（OR 1.05；95%CI 0.85 至 1.3），TAVI 和 SAVR 之间的死亡率无差异。性别之间治疗效果的差异在 1 年（p=0.02）和 2 年（p=0.04）时均具有统计学意义。在女性中，TAVI 的死亡率比 SAVR 低 26%至 31%。在男性中，TAVI 和 SAVR 之间的死亡率无差异。
