Sex-specific differences in patient-centered outcomes after transcatheter aortic valve replacement
D Tomii, J L Lanz, D H Heg, O C Cozzi, H T Thiele, W K K Kim, M J Joner, L C Conradi, S T Toggweiler, B P Prendergast, S W Windecker, T P PilgrimAbstract
Background
Sex-specific disparities in patient-reported outcomes amongst patients undergoing transcatheter aortic valve replacement (TAVR) are not fully investigated.
Objectives
To evaluate sex-based differences in clinical outcomes and health status following transfemoral TAVR in patients with symptomatic severe aortic stenosis.
Methods
Patients in the investigator-initiated, multicenter SCOPE I randomized trial were stratified by sex. Outcomes of interest included vital status and patient-reported disease-specific health status, with an integrated patient-centered outcome defined as being alive with good health status (Kansas City Cardiomyopathy Questionnaire overall summary score [KCCQ-OS] ≥75 without a decline of >10 points from baseline).
Results
Of 732 patients who underwent TAVR, 692 (394 female and 298 male) were included in the analysis of patient-centered outcome. At baseline, female patients had a higher surgical risk and higher prevalence of advanced heart failure symptoms and frailty, whereas male patients had a greater comorbidity burden. Female patients had lower baseline KCCQ-OS, which persisted after TAVR, leading to a lower likelihood of achieving KCCQ-OS ≥75 at 1 year (64.4% vs. 74.2%). In contrast, male patients had consistently higher all-cause mortality throughout 3 years of follow-up (26.3% vs. 19.5%). These contrasting patterns in patient-reported health status and survival resulted in a similar proportion of patients who were alive with good health status at 3 years between groups (42.7% vs. 46.1%).
Conclusions
In this post-hoc analysis of SCOPE I, male and female patients achieved a similar rate of the patient-centered outcome up to 3 years after TAVR, despite contrasting patterns in patient-reported health status and survival.