title: A gender based analysis of predictors of all cause death after transcatheter aortic valve implantation.
abstract: The impact of gender-related pathophysiologic features of severe aortic stenosis on transcatheter aortic valve implantation (TAVI) outcomes remains to be determined, as does the consistency of predictors of mortality between the genders. All consecutive patients who underwent TAVI at 6 institutions were enrolled in this study and stratified according to gender. Midterm all-cause mortality was the primary end point, with events at 30 days and at midterm as secondary end points. All events were adjudicated according to Valve Academic Research Consortium definitions. Eight hundred thirty-six patients were enrolled, 464 (55.5%) of whom were female. At midterm follow-up (median 365 days, interquartile range 100 to 516) women had similar rates of all-cause mortality compared with men (18.1% vs 22.6%, p = 0.11) and similar incidence of myocardial infarction and cerebrovascular accident. Gender did not affect mortality also on multivariate analysis. Among clinical and procedural features, glomerular filtration rate <30 ml/min/1.73 m(2) (hazard ratio [HR] 2.55, 95% confidence interval [CI] 1.36 to 4.79) and systolic pulmonary arterial pressure >50 mm Hg (HR 2.26, 95% CI 1.26 to 4.02) independently predicted mortality in women, while insulin-treated diabetes (HR 3.45, 95% CI 1.47 to 8.09), previous stroke (HR 3.42, 95% CI 1.43 to 8.18), and an ejection fraction <30% (HR 3.82, 95% CI 1.41 to 10.37) were related to mortality in men. Postprocedural aortic regurgitation was independently related to midterm mortality in the 2 groups (HR 11.19, 95% CI 3.3 to 37.9). In conclusion, women and men had the same life expectancy after TAVI, but different predictors of adverse events stratified by gender were demonstrated. These findings underline the importance of a gender-tailored clinical risk assessment in TAVI patients.
authors.affiliation: Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy. Electronic address: federico.conrotto@gmail.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Conrotto
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Division of Cardiac Surgery, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Salizzoni
authors.affiliation: Division of Cardiology, Istituto Humanitas, Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
authors.affiliation: University Medical Center, Utrecht, The Netherlands.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.affiliation: University Medical Center, Utrecht, The Netherlands.
authors.forename: Freek
authors.initials: F
authors.lastname: Nijhoff
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Gasparetto
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.affiliation: Division of Cardiology, Istituto Humanitas, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferrante
authors.affiliation: Division of Cardiology, Istituto Humanitas, Milan, Italy.
authors.forename: Marco Luciano
authors.initials: ML
authors.lastname: Rossi
authors.affiliation: University Medical Center, Utrecht, The Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Stella
authors.affiliation: Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy.
authors.forename: Nedy
authors.initials: N
authors.lastname: Brambilla
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Giordana
authors.affiliation: Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Costanza
authors.initials: C
authors.lastname: Grasso
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi Zoccai
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: D'Amico
authors.affiliation: Division of Cardiac Surgery, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.affiliation: Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
mesh_terms: D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors