Women Undergoing TAVR Have a Different Risk Profile and Greater Survival Rate Than Men

May 6, 2016—The Society for Cardiovascular Angiography and Interventions (SCAI) announced that data from one of the largest national registries of transcatheter aortic valve replacement (TAVR) patients show that although women are more likely to experience vascular complications in the hospital, their 1-year survival rate is more favorable than men. The analysis from the Society for Thoracic Surgeons' (STS) and American College of Cardiology’s transcatheter valve therapy registry, the STS/ACC TVT Registry, was presented as a late-breaking clinical trial at the SCAI 2016 scientific sessions in Orlando, Florida.

Jaya Chandrasekhar, MBBS, a postdoctoral research fellow with Roxana Mehran, MD, at the Icahn School of Medicine at Mount Sinai in New York, is the primary author of this report. Dr. Chandrasekhar commented in the SCAI announcement, “Prior to this study, smaller analyses have suggested that men and women have different outcomes following TAVR procedures. We wanted to gain in-depth understanding into the differences between men and women undergoing TAVR procedures from the US national registry and to evaluate the discrepancies by sex in longer-term outcomes.”

As summarized by SCAI, the investigators evaluated in-hospital and 1-year outcomes for 23,652 TAVR patients, including 11,808 women (49.9%) and 11,844 men (51.1%), from 2012 to 2014. Compared to men, women were older, with lower glomerular filtration rate for kidney function but higher prevalence of porcelain aorta and a higher mean STS adult cardiac surgery risk score (9% vs 8%). However, women undergoing TAVR had a lower prevalence of comorbidities, such as coronary artery disease, atrial fibrillation, and diabetes.

The study demonstrated that women were treated more often using nontransfemoral access (45% vs 34%) with smaller sheath and device sizes but had a higher valve cover index than men. Postprocedure, women experienced more in-hospital vascular complications than men (8.27% vs 4.39%; adjusted hazard ratio, 1.7; 95% confidence interval, 1.34–2.14; P < .001) along with a trend for more bleeding (8% vs 5.96%; adjusted hazard ratio, 1.19; 95% confidence interval, 0.98–1.44; P = .08). Despite these complications for women, the in-hospital survival rate was the same as men. Additionally, 1-year mortality was lower in women (21.3%) than in men (24.5%).

In the SCAI announcement, Dr. Chandrasekhar concluded, “These findings are promising for women. There is a suggestion that the lower rate of coronary artery disease in women undergoing TAVR does put them at an advantage for longer-term survival, compared to men. The next step should be to study quality-of-life metrics and outcomes beyond 1 year, including causes for death in both men and women. At the same time, frailty should be better defined to allow appropriate selection of patients for this procedure.”