Impact of Sex Differences on Long-Term Survival Following TAVI in Patients With Aortic Stenosis: Insights From the TAVI-NOR Study

BACKGROUND: The incidence of aortic stenosis (AS) in the older adult population in Western countries is increasing. When left untreated, AS progresses to clinical heart failure, reduced quality of life and functional capacity, and ultimately death. We aimed to assess sex differences in the long-term survival benefits of transcatheter aortic valve implantation (TAVI) in patients with severe AS. METHOD: A total of 600 consecutive patients with AS who underwent TAVI were included. Clinical and echocardiographic data were analysed. Propensity score matching was performed to assess the impact of sex on the survival benefit following TAVI, yielding 213 men and women with similar baseline characteristics. RESULTS: The mean age in the total population was 80.8±6.5 years. Women (49.3%) were older (82.2±5.3 vs 79.5±7.3 years; p<0.001), had more severe AS, higher prevalence of hypertension and basal septal hypertrophy, and higher left ventricular ejection fraction (LVEF) than men. By contrast, the prevalence of diabetes mellitus, cardiovascular disease, overall abnormal electrocardiogram, and atrial fibrillation was higher in men. During a mean follow-up of 59±24 months for men and 66±25 months for women, a total of 279 deaths occurred (125 in women and 154 in men; p=0.039). There was no difference in mortality at 1 and 2 years. The most pronounced benefit was observed at 3-year follow-up, with survival estimates of 92% for women and 84% for men (p=0.006). In a multivariable Cox regression analysis of the propensity-matched cohort, long-term event-free survival was significantly higher among women than men (hazard ratio 0.66; 95% confidence interval 0.49-0.88; p=0.004). CONCLUSIONS: At presentation, women were older, had a higher burden of hypertensive heart disease, more often exhibited concentric hypertrophy with preserved LVEF, and less frequently had atrial fibrillation compared with men. Women had better long-term survival following TAVI, with the most pronounced survival benefit observed at 3 years.