Erinne Ikenna, Hiltner Emily, Bhasin Varun, Parikh Nisharg, Tangel Richard, Chen Chunguang, Russo Mark J, Kassotis John, Sethi Ankur
Division of Cardiology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA,
Division of Cardiology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Cardiology. 2022;147(5-6):557-565. doi: 10.1159/000526255. Epub 2022 Sep 14.
The impact of transcatheter aortic valve replacement (TAVR) on sex disparities has not been well established. This study sought to examine the impact of sex on outcomes following aortic valve replacement (AVR) for aortic stenosis (AS) in the era of routine TAVR.
We performed a cross-sectional analysis of the National Inpatient Sample (2009-18) to study AS visits for all AVR and in-hospital outcomes as a function of sex. Survey estimation commands were used to provide national estimates.
There were an estimated 431,344 surgical AVR (SAVR) and 189,137 TAVR inpatient visits. Mortality was higher in women after SAVR (3.8% ± 0.1 vs. 2.7% ± 0.07, p < 0.001) and TAVR (2.4% ± 0.1 vs. 1.7% ± 0.1, p < 0.001) compared to men. Female patients undergoing SAVR had higher rates of permanent pacemaker (PPM) implantation, stroke, and bleeding (5.9% ± 0.1 vs. 5% ± 0.1, 2.8% ± 0.1 vs. 2.3% ± 0.07, and 37.8% ± 0.8 vs. 29.8% ± 0.6; p < 0.001, respectively) but lower rates of acute kidney injury (AKI) (16.4% ± 0.3 vs. 20.3% ± 0.3, p < 0.001). Women undergoing TAVR had higher rates of stroke and bleeding (2.4% ± 0.1 vs. 1.6% ± 0.09 and 28.7% ± 0.6 vs. 22% ± 0.5; p < 0.001, respectively) but lower rates of PPM and AKI (9.5% ± 0.3 vs. 10.7% ± 0.2 and 11.3% ± 0.3 vs. 13.4% ± 0.3; p < 0.001, respectively). Compared with isolated SAVR, isolated TAVR was associated with lower mortality in women during 2016-18, both after multivariable adjustment (OR = 0.40; 95% CI, 0.27-0.60) and propensity matching (mean difference 0.66% ± 0.2); however, there was no difference in men.
Although women continue to have higher in-hospital mortality following both TAVR and SAVR as compared to men, TAVR is associated with a lower in-hospital mortality in women compared to SAVR. Thus, TAVR may represent a potential intervention to narrow the sex-based disparities in the management of AS.
经导管主动脉瓣置换术（TAVR）对性别差异的影响尚未完全明确。本研究旨在探讨在常规TAVR时代，性别对主动脉瓣狭窄（AS）患者行主动脉瓣置换术（AVR）后预后的影响。
我们对国家住院患者样本（2009 - 2018年）进行了横断面分析，以研究所有AVR手术中因AS就诊的情况以及住院结局与性别的关系。使用调查估计命令来提供全国性估计数据。
据估计，有431,344例外科主动脉瓣置换术（SAVR）和189,137例TAVR住院病例。与男性相比，女性在SAVR（3.8% ± 0.1 vs. 2.7% ± 0.07，p < 0.001）和TAVR（2.4% ± 0.1 vs. 1.7% ± 0.1，p < 0.001）后的死亡率更高。接受SAVR的女性患者永久性起搏器（PPM）植入率、中风发生率和出血率更高（分别为5.9% ± 0.1 vs. 5% ± 0.1，2.8% ± 0.1 vs. 2.3% ± 0.07，以及37.8% ± 0.8 vs. 29.8% ± 0.6；p均< 0.001），但急性肾损伤（AKI）发生率更低（16.4% ± 0.3 vs. 20.3% ± 0.3，p < 0.001）。接受TAVR的女性中风和出血发生率更高（分别为2.4% ± 0.1 vs. 1.6% ± 0.09和28.7% ± 0.6 vs. 22% ± 0.5；p均< 0.001），但PPM和AKI发生率更低（分别为9.5% ± 0.3 vs. 10.7% ± 0.2和11.3% ± 0.3 vs. 13.4% ± 0.3；p均< 0.001）。与单纯SAVR相比，2016 - 2018年期间，单纯TAVR在多变量调整后（OR = 0.40；95% CI，0.27 - 0.60）以及倾向匹配后（平均差异0.66% ± 0.2），女性死亡率更低；然而，男性中无差异。
尽管与男性相比，女性在TAVR和SAVR后住院死亡率仍然更高，但与SAVR相比，TAVR与女性较低的住院死亡率相关。因此，TAVR可能是缩小AS治疗中基于性别的差异的一种潜在干预措施。
