Abstract 14894: The Impact of Coronary Artery Disease on Cardiovascular Events Differs Between Men and Women in the PARTNER Trials
Melissa A Daubert, Ke Xu, Kayla Brown, Rebecca T Hahn, Philippe Pibarot, Jonathon Leipsic, Marie-Annick A Clavel, Sammy Elmariah, Neil J Weissman, Federico M Asch, Omar Khalique, Martin B Leon, Paul C Cremer, Brian R Lindman, Maria Alu, Pamela S Douglas- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Introduction: Among individuals with severe aortic stenosis (AS), there is significant heterogeneity in the burden of coronary artery disease (CAD).
Hypothesis: We hypothesize that a greater CAD burden will be associated with increased adverse events after AS treatment.
Methods: Patients with severe AS in the PARTNER (Placement of Aortic Transcatheter Valves) 1, 2 and 3 trials and registries were categorized by CAD burden. Clinical characteristics, imaging, treatment, and outcomes were compared between those with obstructive CAD [defined invasively as coronary stenosis ≥50%, prior myocardial infarction (MI) or revascularization] and patients with no or non-obstructive CAD (all stenoses <50% and no prior MI or revascularization). The primary endpoint was cardiovascular (CV) death or heart failure (HF) hospitalization at 2 years.
Results: Among 8058 patients with severe AS, 2200 (27.3%) had non-obstructive or no CAD and were more likely to be female (61.2%) with fewer CAD risk factors. Left ventricular (LV) mass index and LV dimensions were smaller and LV ejection fraction was higher among those with non-obstructive or no CAD. TAVR was performed in 72.0% of non-obstructive or no CAD patients and in 81.3% of patients with obstructive CAD (p<0.0001); the remaining patients received SAVR. After adjustment for clinical, imaging, and AS treatment differences, the rate of CV death or HF hospitalization was higher among those with obstructive CAD (HR 1.16, 95% CI: 1.03-1.30, p=0.01). However, there was a significant sex-related difference in the primary outcome particularly between males and females with non-obstructive or no CAD, p interaction =0.003 (Figure).
Conclusions: Patients with a greater burden of CAD had worse clinical outcomes after treatment for severe AS. However, there was a significant interaction by sex. Further study is needed to understand the increased CV risk among females compared to males with non-obstructive or no CAD.