Division of Interventional Cardiology of MedStar, Cardiovascular Research Network at MedStar Washington Hospital Center, 110 Irving Street, Suite 4B-1, Washington, D.C., 20010.
J Invasive Cardiol. 2021 Jun;33(6):E431-E442. doi: 10.25270/jic/20.00528. Epub 2021 May 6.
To evaluate gender differences and mortality trends in a population undergoing transcatheter aortic valve implantation (TAVI) and to analyze the correlates to all-cause mortality at follow-up.
The study comprises a prospective cohort of 592 TAVI patients (53.4% female) treated between 2008 and 2018. Mortality differences between genders at different timepoints were assessed according to log rank test. Predictors of all-cause mortality at follow-up were identified using a univariate model and were then analyzed through multivariate Cox proportional hazard models.
Compared with female patients, males were younger (81 ± 7.5 years vs 84.3 ± 5.3 years) and presented more comorbidities. Twelve female and 8 male patients (3.5%) died in the first 30 days after TAVI. Despite a higher Society of Thoracic Surgeons (STS) score in women, all-cause mortality rates at 30 days and 1 year were comparable. At long-term follow-up, female patients demonstrated better survival rates, despite a higher number of periprocedural complications. Correlates identified in men were the presence of diabetes and previous history of coronary artery bypass grafting, New York Heart Association class III/IV, pulmonary artery systolic pressure, and non-transfemoral access. None of these variables remained significant in the multivariable analysis. In females, only peripheral artery disease was associated with mortality. Shock and need for renal replacement were predictors of mortality in both genders, as was heart failure readmission after discharge. STS score was also shown to correlate with long-term mortality in both genders.
Despite a higher STS score in women, 30-day mortality was not significantly different from men, while women present better clinical outcomes at long-term follow-up.
评估行经导管主动脉瓣置换术（TAVI）患者的性别差异和死亡率趋势，并分析随访期间全因死亡率的相关因素。
本研究纳入了 2008 年至 2018 年期间接受 TAVI 治疗的 592 例患者（53.4%为女性）前瞻性队列。根据对数秩检验评估不同时间点两性之间的死亡率差异。使用单变量模型确定随访期间全因死亡率的预测因素，然后通过多变量 Cox 比例风险模型进行分析。
与女性患者相比，男性患者年龄较小（81±7.5 岁 vs 84.3±5.3 岁）且合并症更多。TAVI 后 30 天内，12 名女性和 8 名男性（3.5%）患者死亡。尽管女性的胸外科医师协会（STS）评分较高，但 30 天和 1 年的全因死亡率相当。在长期随访中，尽管围手术期并发症较多，但女性患者的生存率更高。在男性患者中确定的相关因素为糖尿病和既往冠状动脉旁路移植术史、纽约心脏协会心功能分级 III/IV 级、肺动脉收缩压和非经股动脉入路。这些变量在多变量分析中均无统计学意义。在女性患者中，仅外周动脉疾病与死亡率相关。休克和需要肾脏替代治疗是两性患者死亡的预测因素，出院后心力衰竭再入院也是如此。STS 评分也与两性的长期死亡率相关。
尽管女性的 STS 评分较高，但 30 天死亡率与男性无显著差异，而女性在长期随访中呈现更好的临床结局。
