Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden.
Am Heart J. 2024 Nov;277:27-38. doi: 10.1016/j.ahj.2024.07.018. Epub 2024 Aug 10.
Previous studies on the impact of sex differences after transcatheter aortic valve replacement (TAVR) have shown conflicting results. The aim was to analyze the risk of long-term mortality, heart failure hospitalization, myocardial infarction, stroke, bleeding and aortic valve reintervention in females versus males after TAVR.
This nationwide, population-based cohort study included all patients who underwent TAVR in Sweden between 2008 and 2022 from the SWEDEHEART register. Additional baseline and outcome data were gathered from other national health data registers. Regression standardization was used to adjust for differences between the sexes.
Of 10,475 patients, 4,886 (47%) were female and 5,589 (53%) were male. The mean age was 81 years. The cumulative incidence of mortality at 1, 5, and 10 years was 8% vs. 10%, 38% vs. 45%, and 75% vs. 82% for females and males, respectively. After regression standardization, the risk of all-cause mortality was lower for females (absolute difference at 10 years of 6.4%, 95% confidence interval [CI] 4.4%-8.4%). The mean follow up was 3.1 years (maximum 14.1 years). Females also had a lower risk of major bleeding than males (absolute survival difference at 10 years of 4.0%, 95% CI 1.9%-6.2%), but there was no difference in the risk of heart failure, myocardial infarction, stroke, or reintervention between the sexes.
Females had a higher survival rate and a lower bleeding risk than males after TAVR. Sex-specific factors are important to consider in the management of patients after TAVR.
先前关于经导管主动脉瓣置换术（TAVR）后性别差异影响的研究结果相互矛盾。本研究旨在分析 TAVR 后女性与男性患者的长期死亡率、心力衰竭住院率、心肌梗死、卒中和出血以及主动脉瓣再介入风险。
本研究为一项全国性、基于人群的队列研究，纳入了 2008 年至 2022 年期间在瑞典接受 TAVR 的所有患者，该研究来自 SWEDEHEART 注册登记处。其他国家健康数据登记处还收集了额外的基线和结局数据。使用回归标准化来调整性别差异。
共纳入 10475 例患者，其中 4886 例（47%）为女性，5589 例（53%）为男性。患者平均年龄为 81 岁。女性患者在 1、5 和 10 年时的死亡率累积发生率分别为 8%、10%、38%和 45%、75%和 82%，而男性患者则分别为 10%、10%、45%、45%和 82%。经过回归标准化后，女性患者的全因死亡率风险较低（10 年时的绝对差异为 6.4%，95%置信区间 [CI]：4.4%-8.4%）。平均随访时间为 3.1 年（最长 14.1 年）。女性患者的大出血风险也低于男性（10 年时的绝对生存差异为 4.0%，95% CI：1.9%-6.2%），但两性患者之间的心力衰竭、心肌梗死、卒中和再介入风险无差异。
TAVR 后女性的生存率高于男性，出血风险低于男性。TAVR 后患者的管理中应考虑性别特异性因素。
