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Sex-Based Differences in Outcomes With Transcatheter Aortic Valve Therapy: TVT Registry From 2011 to 2014.

Publication ,  Journal Article
Chandrasekhar, J; Dangas, G; Yu, J; Vemulapalli, S; Suchindran, S; Vora, AN; Baber, U; Mehran, R; STS/ACC TVT Registry,
Published in: J Am Coll Cardiol
December 27, 2016

BACKGROUND: A differential impact of sex has been observed in transcatheter aortic valve replacement (TAVR) outcomes from small observational studies and subgroup analyses of randomized trials. OBJECTIVES: The goal of this study was to compare the in-hospital and 1-year outcomes in male and female subjects from the U.S. nationwide TAVR registry. METHODS: National data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry were used for in-hospital outcomes, and data linked from the Centers for Medicare & Medicaid Services were used to provide 1-year events. Multivariable logistic regression adjustment was performed for in-hospital outcomes. Fine-Gray models were used for nonfatal 1-year outcomes to account for the competing risk of death. RESULTS: From 2011 to 2014, a total of 11,808 (49.9%) women and 11,844 (51.1%) men underwent TAVR. Compared with male patients, female patients were older, with a lower prevalence of coronary artery disease, atrial fibrillation, and diabetes but a higher rate of porcelain aorta, lower glomerular filtration rate, and higher mean Society of Thoracic Surgeons score (9.0% vs. 8.0%; all p < 0.001). Women were treated more often by using nontransfemoral access than men (45.0% vs. 34.0%). Despite using smaller device sizes, women achieved valve cover index ≥8% more often than men (66% vs. 54%). In-hospital vascular complications were higher in women (8.27% vs. 4.39%; adjusted hazard ratio [HR]: 1.70; 95% CI: 1.34 to 2.14; p < 0.001) and a trend toward higher bleeding (8.01% vs 5.96%; adjusted HR: 1.19; 95% CI: 0.99 to 1.44; p = 0.06) was observed; however, 1-year mortality was lower (21.3% vs. 24.5%; adjusted HR: 0.73; 95% CI: 0.63 to 0.85; p < 0.001) in women than in men. CONCLUSIONS: Female patients undergoing TAVR had a different risk profile compared with male patients. Notwithstanding a greater adjusted risk for in-hospital vascular complications, 1-year adjusted survival was superior in female patients.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

December 27, 2016

Volume

68

Issue

25

Start / End Page

2733 / 2744

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Survival Rate
  • Sex Factors
  • Sex Distribution
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
 

Citation

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Chandrasekhar, J., Dangas, G., Yu, J., Vemulapalli, S., Suchindran, S., Vora, A. N., … STS/ACC TVT Registry, . (2016). Sex-Based Differences in Outcomes With Transcatheter Aortic Valve Therapy: TVT Registry From 2011 to 2014. J Am Coll Cardiol, 68(25), 2733–2744. https://doi.org/10.1016/j.jacc.2016.10.041
Chandrasekhar, Jaya, George Dangas, Jennifer Yu, Sreekanth Vemulapalli, Sunil Suchindran, Amit N. Vora, Usman Baber, Roxana Mehran, and Roxana STS/ACC TVT Registry. “Sex-Based Differences in Outcomes With Transcatheter Aortic Valve Therapy: TVT Registry From 2011 to 2014.J Am Coll Cardiol 68, no. 25 (December 27, 2016): 2733–44. https://doi.org/10.1016/j.jacc.2016.10.041.
Chandrasekhar J, Dangas G, Yu J, Vemulapalli S, Suchindran S, Vora AN, et al. Sex-Based Differences in Outcomes With Transcatheter Aortic Valve Therapy: TVT Registry From 2011 to 2014. J Am Coll Cardiol. 2016 Dec 27;68(25):2733–44.
Chandrasekhar, Jaya, et al. “Sex-Based Differences in Outcomes With Transcatheter Aortic Valve Therapy: TVT Registry From 2011 to 2014.J Am Coll Cardiol, vol. 68, no. 25, Dec. 2016, pp. 2733–44. Pubmed, doi:10.1016/j.jacc.2016.10.041.
Chandrasekhar J, Dangas G, Yu J, Vemulapalli S, Suchindran S, Vora AN, Baber U, Mehran R, STS/ACC TVT Registry. Sex-Based Differences in Outcomes With Transcatheter Aortic Valve Therapy: TVT Registry From 2011 to 2014. J Am Coll Cardiol. 2016 Dec 27;68(25):2733–2744.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

December 27, 2016

Volume

68

Issue

25

Start / End Page

2733 / 2744

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Survival Rate
  • Sex Factors
  • Sex Distribution
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment