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

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.