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Canadian Journal of Cardiology

Sex Differences in Infective Endocarditis After Transcatheter Aortic Valve Replacement

      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 = 0.373), 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

      Les pronostics après implantation transcathéter de valvule aortique (ITVA) et des pathologies infectieuses peuvent varier en fonction du sexe.

      Méthodes

      Cette étude multicentrique visait à déterminer les différences entre les sexes pour les caractéristiques cliniques, la prise en charge et le pronostic de l'endocardite infectieuse (EI) après ITVA. Au total, 579 patients (217 femmes, 37,5 %) ayant reçu un diagnostic d'endocardite infectieuse après ITVA ont été inclus rétrospectivement dans le registre 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 culture négative étaient plus fréquentes chez les femmes (9,9 % vs 4,3 %; P = 0,009). Une proportion élevée de patients avait une indication clinique pour une 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 = 0,373), 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 pour une mortalité cumulée 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 de meilleurs pronostics 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 ITVA. Cependant, le sexe féminin était associé à un risque accru de mortalité à deux ans.

      Graphical abstract

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