Abstract
Background
Outcomes after transcatheter aortic valve replacement (TAVR) and infectious diseases
may vary according to sex.
Methods
This multicentre study aimed to determine the sex differences in clinical characteristics,
management, and outcomes of infective endocarditis (IE) after TAVR. A total of 579
patients (217 women, 37.5%) who had the diagnosis of definite IE following TAVR were
included retrospectively from the Infectious Endocarditis After TAVR International
Registry.
Results
Women were older (80 ± 8 vs 78 ± 8 years; P = 0.001) and exhibited a lower comorbidity burden. Clinical characteristics and microbiological
profiles were similar between men and women, but culture-negative IE was more frequent
in women (9.9% vs 4.3%; P = 0.009). A high proportion of patients had a clinical indication for surgery (54.4%
in both groups; P = 0.99), but a surgical intervention was performed in a minority of patients (women
15.2%, men 20.3%; P = 0.13). The mortality rate at index IE hospitalisation was similar in both groups
(women 35.4%, men 31.7%; P = 0.37), but women exhibited a higher mortality rate at 2-year follow-up (63% vs
52.1%; P = 0.021). Female sex remained an independent risk factor for cumulative mortality
in the multivariable analysis (adjusted HR 1.28, 95% CI 1.02-1.62; P = 0.035). After adjustment for in-hospital events, surgery was not associated with
better outcomes in women.
Conclusions
There were no significant sex-related differences in the clinical characteristics
and management of IE after TAVR. However, female sex was associated with increased
2-year mortality risk.
Résumé
Contexte
Le pronostic des patients après implantation de valve aortique par voie percutanée
(TAVI) et après la survenue de pathologies infectieuses peut varier en fonction du
sexe.
Méthodes
Cette étude multicentrique visait à déterminer les différences entre les sexes concernant
les caractéristiques cliniques, la prise en charge et le pronostic de l'endocardite
infectieuse (EI) après TAVI. Au total, 579 patients (217 femmes, 37,5 %) ayant un
diagnostic d'endocardite infectieuse après TAVI ont été inclus rétrospectivement dans
le : Infectious Endocarditis After TAVR International Registry.
Résultats
Les femmes étaient plus âgées (80 ± 8 vs 78 ± 8 ans; P = 0,001) et présentaient un taux de comorbidité plus faible. Les caractéristiques
cliniques et les profils microbiologiques étaient similaires entre les hommes et les
femmes, mais les EI à l'hémoculture négative étaient plus fréquentes chez les femmes
(9,9 % vs 4,3 %; P = 0,009). Une proportion élevée de patients avaient une indication clinique d'intervention
chirurgicale (54,4 % dans les deux groupes; P = 0,99), mais une intervention chirurgicale a été pratiquée pour une minorité de
patients (femmes : 15,2 %, hommes : 20.3 %; P = 0,13). Le taux de mortalité lors de l'hospitalisation pour EI était similaire dans
les deux groupes (femmes 35,4 %, hommes 31,7 %; P = 0,37), mais les femmes présentaient un taux de mortalité plus élevé lors du suivi
à deux ans (63 % contre 52,1 %; P = 0,021). Le sexe féminin est resté un facteur de risque indépendant de mortalité
dans l'analyse multivariée (Rapport des risques instantanés ajusté 1,28, IC à 95 %
1,02-1,62; P = 0,035). Après ajustement en fonction des événements indésirables survenus à l'hôpital,
la chirurgie n'était pas associée à un meilleur pronostic chez les femmes.
Conclusions
Il n'y avait pas de différences significatives liées au sexe dans les caractéristiques
cliniques et la prise en charge de l'EI après TAVI. Cependant, le sexe féminin était
associé à un risque accru de mortalité à deux ans.
Graphical abstract
Graphical Abstract
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The Lancet Women and Cardiovascular Disease Commission: reducing the global burden by 2030.Lancet. 2021; 397: 2385-2438
- Sex/gender differences in cardiovascular disease prevention what a difference a decade makes.Circulation. 2011; 124: 2145-2154
- Sexual dimorphism and gender in infectious diseases.Front Immunol. 2021; 12698121
- Revisiting sex equality with transcatheter aortic valve replacement outcomes: a collaborative, patient-level meta-analysis of 11,310 patients.J Am Coll Cardiol. 2015; 66: 221-228
- Sex-based differences in outcomes with transcatheter aortic valve therapy: TVT Registry from 2011 to 2014.J Am Coll Cardiol. 2016; 68: 2733-2744
- Long-term outcomes with transcatheter aortic valve replacement in women compared with men: evidence from a meta-analysis.JACC Cardiovasc Interv. 2018; 11: 24-35
- Gender differences in infective endocarditis: Pre- and co-morbid conditions lead to different management and outcomes in female patients.Scand J Infect Dis. 2007; 39: 101-107
- Sex differences in native-valve infective endocarditis in a single tertiary-care hospital.Am J Cardiol. 2010; 106: 92-98
- Prosthetic valve endocarditis after transcatheter valve replacement: a systematic review.JACC Cardiovasc Interv. 2015; 8: 334-346
- Long-term outcomes after infective endocarditis after transcatheter aortic valve replacement.Circulation. 2020; 142: 1497-1499
- Association between transcatheter aortic valve replacement and subsequent infective endocarditis and in-hospital death.JAMA. 2016; 316: 1083-1092
- 2015 ESC guidelines for the management of infective endocarditis. The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM).Eur Heart J. 2015; 36: 3075-3128
- Updated standardised end point definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium 2 consensus document.J Am Coll Cardiol. 2012; 60: 1438-1454
- Influence of sex on left-sided infective endocarditis.Rev Esp Cardiol. 2010; 63: 1497-1500
- Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases.Clin Infect Dis. 2010; 51: 131-140
- Sustained sex-based treatment differences in acute coronary syndrome care: insights from the American Heart Association Get With The Guidelines Coronary Artery Disease Registry.Clin Cardiol. 2018; 41: 758-768
- Sex differences in the use of statins in community practice.Circ Cardiovasc Qual Outcomes. 2019; 12e005562
- Trends in gender differences in cardiac care and outcome after acute myocardial infarction in western Sweden: a report from the Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART).J Am Heart Assoc. 2015; 4e001995
- Gender-dependent differences in outcome after the treatment of infection in hospitalised patients.JAMA. 1999; 282: 2143-2148
- Gender based analysis of a population series of patients hospitalised with infective endocarditis in Portugal—how do women and men compare?.Int J Cardiovasc Sci. 2021; 34: 347-355
- Sex differences in the utilisation and outcomes of cardiac valve replacement surgery for infective endocarditis: insights from the National Inpatient Sample.J Am Heart Assoc. 2021; 10e020095
Article Info
Publication History
Published online: July 13, 2022
Accepted:
July 3,
2022
Received:
May 11,
2022
Footnotes
See page 1424 for disclosure information.
Identification
Copyright
© 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
