Department of Medical Sciences, Cardiology, Uppsala University, Uppsala Clinical Research Center, Uppsala, Sweden
Department of Medical Sciences, Cardiology, Uppsala University, Uppsala Clinical Research Center, Uppsala, Sweden.
Open Heart. 2024 Jul 23;11(2):e002725. doi: 10.1136/openhrt-2024-002725.
To compare long-term cardiovascular (CV) outcomes between men and women with aortic stenosis (AS) undergoing aortic valve replacement (AVR) by the type of valve implant.
The study population consisted of 14 123 non-selected patients with AS undergoing first-time AVR and included in the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry during 2008-2016. Comparisons were made between men and women and type of valve implant (ie, surgical implantation with a mechanical (mSAVR) (n=1 966) or biological valve (bioSAVR) (n=9 801)) or by a transcatheter approach (TAVR) (n=2 356). Outcomes included all-cause mortality, ischaemic stroke, major bleeding, thromboembolic events, heart failure and myocardial infarction, continuously adjusted for significant comorbidities and medical treatment.
In the mSAVR cohort, there were no significant sex differences in any CV events. In the bioSAVR cohort, a higher risk of death (HR: 1.14; 95% CI: 1.04 to 1.26, p=0.007) and major bleeding (HR: 1.41; 95% CI: 1.18 to 1.69, p<0.001) was observed in men. In the TAVR cohort, men suffered a higher risk of death (HR: 1.24; 95% CI: 1.07 to 1.45, p=0.005), major bleeding (HR: 1.35; 95% CI: 1.00 to 1.82, p=0.022) and thromboembolism (HR: 1.35, 95% CI: 1.00 to 1.82, p=0.047).
No significant long-term difference in CV events was noted between men and women undergoing AVR with a mechanical aortic valve. In both the bioSAVR and TAVR cohort, mortality was higher in men who also had an increased incidence of several other CV events.
比较经主动脉瓣置换术（AVR）治疗的主动脉瓣狭窄（AS）男性和女性患者的长期心血管（CV）结局与瓣膜植入类型的关系。
该研究人群包括 2008 年至 2016 年期间在瑞典 Web 系统增强和发展心脏病循证治疗评价（SWEDEHEART）登记处纳入的 14123 例非选择性初次 AVR 的 AS 患者。对男性和女性以及瓣膜植入类型（即外科植入机械瓣膜（mSAVR）（n=1966）或生物瓣膜（bioSAVR）（n=9801））或经导管途径（TAVR）（n=2356）进行比较。结果包括全因死亡率、缺血性卒中和主要出血、血栓栓塞事件、心力衰竭和心肌梗死，均连续调整了重要合并症和药物治疗。
在 mSAVR 队列中，CV 事件在男女之间无显著差异。在 bioSAVR 队列中，男性死亡（HR：1.14；95%CI：1.04 至 1.26，p=0.007）和主要出血（HR：1.41；95%CI：1.18 至 1.69，p<0.001）风险较高。在 TAVR 队列中，男性死亡率（HR：1.24；95%CI：1.07 至 1.45，p=0.005）、主要出血（HR：1.35；95%CI：1.00 至 1.82，p=0.022）和血栓栓塞（HR：1.35，95%CI：1.00 至 1.82，p=0.047）风险较高。
在接受机械主动脉瓣 AVR 的男性和女性患者中，CV 事件的长期差异无统计学意义。在 bioSAVR 和 TAVR 队列中，男性死亡率较高，同时发生其他几种 CV 事件的发生率也较高。
