January 02, 2018
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WIN-TAVI: Mortality, stroke low in women 1 year after TAVR

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The incidence of mortality and stroke was low at 1 year in women at intermediate or high surgical risk who underwent transcatheter aortic valve replacement, according to new data from the WIN-TAVI registry.

As Cardiology Today’s Intervention previously reported, WIN-TAVI is the first all-female TAVR registry; 30-day outcomes were published in May 2016.

For the present analysis, Alaide Chieffo, MD, from the department of cardiology at San Raffaele Scientific Institute in Milan, and colleagues determined 1-year outcomes after TAVR in 1,019 intermediate- to high-risk women (mean age, 82 years; mean EuroSCORE I, 17.8%; mean Society of Thoracic Surgeons Predicted Risk of Mortality, 8.3%) from 18 European sites and one U.S. site.

The primary endpoint was 1-year Valve Academic Research Consortium (VARC-2) efficacy, defined as mortality, stroke, MI, hospitalization for valve-related symptoms, as well as HF or valve-related dysfunction beyond 30 days. The key secondary endpoint was death or stroke at 1 year.

The primary endpoint occurred in 10.9% of patients beyond 30 days and in 16.5% of patients at 1 year, Chieffo and colleagues wrote.

The rate of death or stroke at 1 year was 13.9%; death occurred in 12.5% and stroke in 2.2%, according to the researchers.

Independent predictors of the VARC-2 efficacy endpoint included prior coronary revascularization (HR = 1.72; 95% CI, 1.17-2.52) and EuroSCORE I (HR = 1.02; 95% CI, 1-1.04).

Independent predictors of death or stroke at 1 year included EuroSCORE I (HR = 1.02; 95% CI, 1-1.04), atrial fibrillation at baseline (HR = 1.58; 95% CI, 1.07-2.33) and previous PCI (HR = 1.5; 95% CI, 1.03-2.19), according to the researchers.

After adjustment, the researchers found no association between 1-year TAVR outcomes and history of pregnancy or any other sex-specific factors.

“Despite greater procedural complications, women demonstrate more favorable 1-year survival following TAVR compared with men, as a function of different baseline risks; lower prevalence of CAD, diabetes and AF; and higher baseline LVEF,” Chieffo and colleagues wrote. “In the current report we show that 1-year incidence of the VARC-2 efficacy endpoint was almost one-half the previously reported rates in prior TAVR studies with primarily older-generation devices.” – by Erik Swain

Disclosures: Chieffo reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.