Lodo Vittoria, Italiano Enrico G, Weltert Luca, Zingarelli Edoardo, Perrucci Chiara, Pietropaolo Claudio, Buono Gabriella, Centofanti Paolo
Department of Cardiac Surgery, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy.
Division of Cardiac Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy.
Front Cardiovasc Med. 2024 Jul 17;11:1417430. doi: 10.3389/fcvm.2024.1417430. eCollection 2024.
This study aimed to compare gender-related differences in short- and long-term outcomes after transcatheter aortic valve implantation.
Patients who underwent transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) from September 2017 to December 2022 were enrolled. The primary endpoint was 5-year all-cause mortality. The secondary endpoints were 30-day mortality and the incidence of post-procedural complication. Patients were separated according to gender before statistical analysis. To compare patients with similar baseline characteristics, we performed a propensity matching.
A total of 704 patients [females, 361 (51.3%); males, 343 (48.7%)] were enrolled. Compared to women, men had a higher incidence of smoking (40.5% vs. 14.7%, < 0.001), diabetes (32.9% vs. 25.1%, < 0.025), peripheral artery disease (35.8% vs. 18.3%, < 0.001), and previous cardiac surgery (13.7% vs. 7.2%, = 0.006) and a lower ejection fraction [56.6 (9.3) vs. 59.8 (7.5), = 0.046]. Female patients were frailer at the time of the procedure [poor mobility rate, 26% vs. 11.7%, < 0.001; CCI (Charlson comorbidity index) 2.4 (0.67) vs. 2.32 (0.63), = 0.04]. Despite these different risk profiles, no significant differences were reported in terms of post-procedural outcomes and long-term survival. Propensity score matching resulted in a good match of 204 patients in each group (57.9% of the entire study population). In the matched cohort, men had a significantly higher incidence of new pacemaker implantation compared to women [33 (16.2%) vs. 18 (8.8%)]. The Kaplan-Meier 5-year survival estimate was 82.4% for women and 72.1% for men, = 0.038.
Female gender could be considered as a predictor of better outcomes after TAVI.
本研究旨在比较经导管主动脉瓣植入术后短期和长期结果中的性别差异。
纳入2017年9月至2022年12月因严重主动脉瓣狭窄（AS）接受经导管主动脉瓣植入术（TAVI）的患者。主要终点是5年全因死亡率。次要终点是30天死亡率和术后并发症发生率。在进行统计分析前，根据性别对患者进行分组。为比较具有相似基线特征的患者，我们进行了倾向匹配。
共纳入704例患者[女性361例（51.3%）；男性343例（48.7%）]。与女性相比，男性吸烟率更高（40.5%对14.7%，<0.001）、糖尿病患病率更高（32.9%对25.1%，<0.025）、外周动脉疾病发生率更高（35.8%对18.3%，<0.001）、既往心脏手术史比例更高（13.7%对7.2%，=0.006），且射血分数更低[56.6（9.3）对59.8（7.5），=0.046]。女性患者在手术时身体更虚弱[行动不便率，26%对11.7%，<0.001；Charlson合并症指数（CCI）2.4（0.67）对2.32（0.63），=0.04]。尽管存在这些不同的风险特征，但术后结果和长期生存率方面未报告显著差异。倾向评分匹配使每组204例患者匹配良好（占整个研究人群的57.9%）。在匹配队列中，男性新植入起搏器的发生率显著高于女性[33例（16.2%）对18例（8.8%）]。女性的Kaplan-Meier 5年生存率估计为82.4%，男性为72.1%，=0.038。
女性可被视为TAVI术后预后较好的预测因素。
