Impact of sex on management and survival in aortic stenosis

Abstract

Increasing attention has been paid to sex differences in recent studies, but only a few have focused on such differences in aortic stenosis (AS). We sought to evaluate the differences between genders in AS outcomes and management. We included 2429 patients(51.5% men; 49.5% women) with severe AS. Women were olde r( P < 0.001), more often symptomatic( P = 0.007), and presented with smaller aortic valve area( P < 0.001), and greater ejection fraction( P < 0.001) than men. Despite that women have a longer life expectancy than men in the general population, estimated five-year survival of patients with severe AS was lower for women compared to men(62 ± 2% versus 69 ± 1% respectively, P < 0.001). The 5-year survival was lower compared to expected survival, especially for women (62 ± 2% vs. 71% for women and 69 ± 1% vs. 71% for men). The cumulative 5-years incidence of aortic valve replacement (AVR) was 79 ± 2% for men, and only 70 ± 2% for women ( P < 0.001) and, being male was independently predictive of AVR (OR:1.49 [1.18–1.97]; P = 0.011). After age-matching, women still presented with more symptoms ( P = 0.004), lower AVR rates (64.4% versus 69.1%, P = 0.018) and lower 5-year survival than men (66 ± 2%[expected:75%] versus 68 ± 2% [expected 70%], P < 0.001) ( Fig. 1 ). Women with severe AS present at a more advance stage of the disease, at older ages with more symptoms, and incur higher mortality than men. This excess mortality is related to a combination of late diagnosis and a less frequent and later referral for AVR than in men. This justifies appropriate measures to improve the situation and to ensure that both sexes receive equivalent care.