症状性重度主动脉瓣狭窄患者的性别差异。
Sex disparities in patients with symptomatic severe aortic stenosis.
机构信息
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
Department of Family Medicine and Public Health, University of San Diego, San Diego, CA; Boston Consulting Group, Boston, MA.
出版信息
Am Heart J. 2021 Jul;237:116-126. doi: 10.1016/j.ahj.2021.01.021. Epub 2021 Mar 17.
BACKGROUND
We evaluated whether there is equitable distribution across sexes of treatment and outcomes for aortic valve replacement (AVR), via surgical (SAVR) or transcatheter (TAVR) methods, in symptomatic severe aortic stenosis (ssAS) patients.
METHODS
Using de-identified data, we identified 43,822 patients with ssAS (2008-2016). Multivariate competing risk models were used to determine the likelihood of any AVR, while accounting for the competing risk of death. Association between sex and 1-year mortality, stratified by AVR status, was evaluated using multivariate Cox regression models with AVR as a time-dependent variable.
RESULTS
Among patients with ssAS, 20,986 (47.9%) were female. Females were older (median age 81 vs. 78, P<0.001), more likely to have body mass index <20 (8.5% vs. 3.5%), and home oxygen use (4.4% vs. 3.4%, P<0001 for all). Overall, 12,129 (27.7%) patients underwent AVR for ssAS. Females were less likely to undergo AVR compared with males (24.1% vs. 31.0%, adjusted hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.77-0.83), but when treated, were more likely to undergo TAVR (37.9% vs. 30.9%, adjusted HR 1.21, 95% CI 1.15-1.27). Untreated females and males had similarly high rates of mortality at 1 year (31.1% vs. 31.3%, adjusted HR 0.98, 95% CI 0.94-1.03). Among those undergoing AVR, females had significantly higher mortality (10.2% vs. 9.4%, adjusted HR 1.24, 95% CI 1.10-1.41), driven by increased SAVR-associated mortality (9.0% vs. 7.6%, adjusted HR 1.43, 95% CI 1.21-1.69).
CONCLUSIONS
Treatment rates for ssAS patients remain suboptimal with disparities in female treatment.
背景
我们评估了在有症状的重度主动脉瓣狭窄（ssAS）患者中，经导管（TAVR）或外科（SAVR）方法行主动脉瓣置换术（AVR）时，男女之间的治疗和结局是否存在公平分配。
方法
使用去识别数据，我们确定了 43822 例 ssAS 患者（2008-2016 年）。使用多变量竞争风险模型来确定任何 AVR 的可能性，同时考虑死亡的竞争风险。使用多变量 Cox 回归模型评估 AVR 状态分层时性别与 1 年死亡率之间的关系，其中 AVR 为时间依赖性变量。
结果
在有 ssAS 的患者中，20986 例（47.9%）为女性。女性年龄更大（中位数年龄 81 岁 vs. 78 岁，P<0.001），更有可能体重指数<20（8.5% vs. 3.5%），并且在家中使用氧气（4.4% vs. 3.4%，均<0.001）。总体而言，12129 例（27.7%）患者因 ssAS 而行 AVR。与男性相比，女性行 AVR 的可能性较小（24.1% vs. 31.0%，调整后的危险比[HR]0.80，95%置信区间[CI]0.77-0.83），但在接受治疗时，更有可能接受 TAVR（37.9% vs. 30.9%，调整后的 HR 1.21，95% CI 1.15-1.27）。未治疗的女性和男性在 1 年时的死亡率相似（31.1% vs. 31.3%，调整后的 HR 0.98，95% CI 0.94-1.03）。在接受 AVR 的患者中，女性的死亡率明显更高（10.2% vs. 9.4%，调整后的 HR 1.24，95% CI 1.10-1.41），这主要是由于 SAVR 相关死亡率增加（9.0% vs. 7.6%，调整后的 HR 1.43，95% CI 1.21-1.69）。
结论
ssAS 患者的治疗率仍然不理想，女性的治疗存在差异。
Zotero 插件