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Publications

Journal Article Ahead of print 1 citation

PubMed: 41944165 DOI: 10.1161/JAHA.125.045293

Sex-Related Differences in the Management and Outcomes of Patients Across the Spectrum of Aortic Stenosis.

J Am Heart Assoc

Authors: Augustin Coisne, David Montaigne, Andrea Scotti, Samy Aghezzaf, Marjorie Richardson, Sandro Ninni, Gilles Lemesle, Arnaud Sudre, Laura Butruille, Thomas Modine, André Vincentelli, Marie Jungling, Marie-Annick Clavel, Julia Grapsa, Rebecca T Hahn, Martin B Leon, Azeem Latib, Juan F Granada, Christophe Bauters

Affiliations

  • Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID F-59000 Lille France.
  • Cardiovascular Research Foundation New York NY USA.
  • Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center Albert Einstein College New York NY USA.
  • Heart and Lung Institute University Hospital of Lille F-59000 France.
  • Univ. Lille F-59000 France.
  • Institut Pasteur of Lille, Inserm U1011 F-59000 Lille France.
  • FACT (French Alliance for Cardiovascular Trials) Paris France.
  • UMCV, Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux Pessac France.
  • Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute) Université Laval Quebec City Canada.
  • Department of Cardiology Brigham and Women's Hospital, Harvard Medical School Boston MA USA.
  • New York-Presbyterian/Columbia University Medical Center, New York NY USA.
  • Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille U1167 France.

Abstract

BACKGROUND

There are conflicting data on sex differences in patients with aortic stenosis (AS). We aimed to investigate sex differences in management and outcomes across the spectrum of outpatients with AS.

METHODS

Between 2016 and 2017, consecutive all-comer outpatients with mild (peak aortic velocity=2.5-2.9 m/s), moderate (3-3.9 m/s), or severe (≥4 m/s) native AS were included by 117 cardiologists and followed up for 5 years for aortic valve replacement (AVR) and cause of death. Outcomes were compared by sex using inverse probability of treatment weighting adjustment.

RESULTS

Among the 2704 patients, 1257 (46.5%) were women. Women were more symptomatic (New York Heart Association class ≥2, 67.7% versus 54.6%; P<0.001) and had a higher proportion of severe AS (17.5% versus 14.3%, P=0.02) at inclusion. During follow-up (median, 5.0 [interquartile range, 3.4-5.5]) years, 993 AVRs (488 surgical and 505 transcatheter) and 1098 deaths occurred. After inverse probability of treatment weight adjustment, women had better survival (adjusted hazard ratio [HR], 0.81 [95% CI, 0.71-0.93]; P=0.003) but similar cardiovascular death (P=0.99) compared with men. Interestingly, the higher survival in women was observed only in mild AS (adjusted HR, 0.71 [95% CI, 0.56-0.90]; P=0.005). The inverse probability of treatment weight-adjusted cumulative incidence of AVR by AS severity revealed no significant differences between women and men among patients across the AS spectrum. Cumulative incidence of surgical AVR was lower in women than in men (P=0.02).

CONCLUSIONS

Women had a similar referral rate for AVR (versus men), with a lower proportion undergoing SAVR, allowing similar outcomes between women and men with moderate and severe AS. The lower mortality rate in women was restricted to mild AS presentation.

MeSH

Constriction, Pathologic, Aortic Valve Stenosis, Heart Diseases, Incidence, Probability, Sex Characteristics, Sex, Therapeutics, Outpatients, Sex Differences