Clinical impact of sex differences and procedural setting in transcatheter aortic valve implantation.

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Revascularization Medicine Pub Date : 2024-09-24 DOI:10.1016/j.carrev.2024.09.014
Lis Victória Ravani, Henrique Barbosa Ribeiro, Pedro Calomeni, Fábio Sandoli de Brito, Fernando Bernardi, Pedro Lemos, Fausto Feres, Dimytri Alexandre Siqueira, Ricardo Costa, Rogério Sarmento-Leite, Fernanda Mangione, José Armando Mangione, Luiz Eduardo Koenig São Thiago, Valter Correia de Lima, Adriano Dias Dourado Oliveira, Marcos Antônio Marino, Carlos José Francisco Cardoso, Paulo Ricardo Avancini Caramori, Rogério Tadeu Tumelero, Antenor Lages Fortes Portela, Maurício Lopes Prudente, Leônidas Alvarenga Henriques, Fabio Solano de Freitas Souza, Cristiano Guedes Bezerra, Guy Fernandes de Almeida Prado Junior, Leandro Zacarias Figueiredo de Freitas, Ederlon Ferreira Nogueira, George César Ximenes Meirelle, Renato Bastos Pope, Ênio Eduardo Guérios, Pedro Beraldo de Andrade, Luciano de Moura Santos, Mauricio Felippi de Sá Marchi, Vinicius Borges Cardozo Esteves, Alexandre Abizaid
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Abstract

Background: Transcatheter aortic valve implantation (TAVI) is a well-established treatment for symptomatic patients with aortic stenosis. Yet, the impact of sex differences and public vs. private procedural setting on TAVI outcomes remain uncertain.

Methods: The RIBAC-NT (Brazilian Registry for Evaluation of Transcatheter Aortic Valve Replacement Outcomes) dataset included 3194 TAVI patients from 2009 to 2021. This retrospective analysis explored disparities in baseline characteristics, procedural and in-hospital outcomes stratifying patients by sex and procedural setting. Temporal trends were also investigated.

Results: We included 1551 (49 %) female and 1643 (51 %) male patients. Women were older (83 [78-87] vs. 81 [75-85] years; p < 0.01) but had a lower prevalence of diabetes mellitus (30.2 % vs. 36.3 %, p < 0.01) and coronary artery disease (39.0 % vs. 52.2 %, p < 0.01). However, women had a 3-fold higher higher risk of life-threatening bleeding (6.1 % vs. 2.4 %, p < 0.01). Women presented higher procedural and in-hospital mortality rates (4.4 % vs. 2.5 % and 7.7 % vs. 4.5 %, all p < 0.01, respectively). Although public hospitals presented ~2-fold higher procedural mortality rate compared with private settings (5.0 % vs. 2.7 %, p < 0.01), after multivariable analysis procedural setting was not independently associated with in-hospital mortality.

Conclusions: Women had higher procedural and in-hospital mortality rates after TAVI as compared with men, while facing higher life-threatening bleeding and adverse events rates. Although public hospitals exhibited higher mortality rates than private centers, procedural setting was not independently associated with in-hospital mortality.

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经导管主动脉瓣植入术中性别差异和手术环境对临床的影响。
背景:经导管主动脉瓣植入术(TAVI)是治疗有症状的主动脉瓣狭窄患者的一种行之有效的方法。然而,性别差异和公共与私人手术环境对 TAVI 结果的影响仍不确定:RIBAC-NT(巴西经导管主动脉瓣置换术结果评估登记)数据集包括2009年至2021年的3194名TAVI患者。这项回顾性分析探讨了基线特征、手术和住院结果的差异,并按性别和手术环境对患者进行了分层。同时还研究了时间趋势:我们纳入了 1551 例(49%)女性患者和 1643 例(51%)男性患者。女性年龄更大(83 [78-87] 岁 vs. 81 [75-85]岁;P 结论:女性的手术和住院率更高:与男性相比,女性在 TAVI 术后的手术死亡率和院内死亡率较高,同时危及生命的出血率和不良事件发生率也较高。虽然公立医院的死亡率高于私立医院,但手术环境与院内死亡率并无独立关联。
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来源期刊
Cardiovascular Revascularization Medicine
Cardiovascular Revascularization Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.30
自引率
5.90%
发文量
687
审稿时长
36 days
期刊介绍: Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.
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