Pighi Michele, Piazza Nicolo, Martucci Giuseppe, Lachapelle Kevin, Perrault Louis P, Asgar Anita W, Lauck Sandra, Webb John G, Popma Jeffrey J, Kim Dae H, Lefèvre Thierry, Labinaz Marino, Lamy Andre, Peterson Mark D, Arora Rakesh C, Noiseux Nicolas, Trnkus Amanda, Afilalo Jonathan
Division of Cardiology (M.P., N.P., G.M.), McGill University Health Centre, Montreal, QC, Canada.
Division of Cardiac Surgery (K.L.), McGill University Health Centre, Montreal, QC, Canada.
Circ Cardiovasc Qual Outcomes. 2019 Mar;12(3):e005363. doi: 10.1161/CIRCOUTCOMES.118.005363.
Background Women account for a large proportion of patients treated with transcatheter aortic valve replacement, yet there remain conflicting reports about the effect of sex on outcomes. Moreover, the sex-specific prevalence and prognostic impact of frailty has not been systematically studied in the context of transcatheter aortic valve replacement. Methods and Results A preplanned analysis of the FRAILTY-AVR study (Frailty Aortic Valve Replacement) was performed to analyze the determinants of outcomes in older women and men undergoing transcatheter aortic valve replacement. FRAILTY-AVR was a multinational, prospective, observational cohort assembled at 14 institutions in North America and Europe from 2012 to 2017. Multivariable logistic regression models were stratified by sex and adjusted for covariates. Interaction between sex and each of these covariates was assessed. The primary outcome was 12-month mortality, and the secondary outcome was 1-month composite mortality or major morbidity. The cohort consisted of 340 women and 419 men. Women were older and had higher predicted risk of mortality. Women were more likely to have physical frailty traits, but not cognitive or psychosocial frailty traits, and global indices of frailty were similarly associated with adverse events regardless of sex. Women were more likely to require discharge to a rehabilitation facility, particularly those with physical frailty at baseline, although their functional status was similar to men at 12 months. The risk of 1-month mortality or major morbidity was greater in women, particularly those treated with larger prostheses. The risk of 12-month mortality was not greater in women, with the exception of those with pulmonary hypertension, in whom, there was a significant interaction for increased mortality. Conclusions The present study highlights sex-specific differences in older adults undergoing transcatheter aortic valve replacement and draws attention to the impact of physical frailty in women and their potential risk associated with oversized prostheses and pulmonary hypertension.
女性在接受经导管主动脉瓣置换术治疗的患者中占很大比例，但关于性别对治疗结果的影响仍存在相互矛盾的报道。此外，在经导管主动脉瓣置换术背景下，衰弱的性别特异性患病率及其对预后的影响尚未得到系统研究。
对FRAILTY-AVR研究（衰弱主动脉瓣置换术）进行了预先计划的分析，以分析接受经导管主动脉瓣置换术的老年女性和男性治疗结果的决定因素。FRAILTY-AVR是一项多中心、前瞻性、观察性队列研究，于2012年至2017年在北美和欧洲的14个机构开展。多变量逻辑回归模型按性别分层，并对协变量进行了调整。评估了性别与每个协变量之间的相互作用。主要结局为12个月死亡率，次要结局为1个月综合死亡率或严重并发症。该队列由340名女性和419名男性组成。女性年龄更大，预测的死亡风险更高。女性更有可能具有身体衰弱特征，但没有认知或心理社会衰弱特征，并且无论性别，衰弱的总体指标与不良事件的相关性相似。女性更有可能需要出院后前往康复机构，尤其是那些基线时存在身体衰弱的女性，尽管她们在12个月时的功能状态与男性相似。女性发生1个月死亡率或严重并发症的风险更高，尤其是那些接受较大尺寸人工瓣膜治疗的女性。除患有肺动脉高压的女性外，女性12个月死亡率风险并不更高，而患有肺动脉高压的女性死亡率增加存在显著的相互作用。
本研究突出了接受经导管主动脉瓣置换术的老年人中的性别特异性差异，并提请注意身体衰弱对女性的影响及其与过大尺寸人工瓣膜和肺动脉高压相关的潜在风险。
