Sex-based differences of the impact of aortic valve calcium score on mortality and post-procedural outcomes after trans-catheter aortic valve replacement

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Introduction</jats:title> <jats:p>Sex based differences exist in the presentation, outcomes, and management of cardiovascular diseases. Although aortic valve calcium (AVC) score has been postulated to be associated with post-procedural outcomes after transcatheter aortic valve replacement (TAVR), data on the impact of AVC score on procedural outcomes after TAVR based on sex have been scarce.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>The aim of the present study was to elucidate sex related differences in the prognostic impact of AVC score as a predictor of post-procedural outcomes and mortality in patients with severe aortic stenosis (AS) who underwent TAVR.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We retrospectively abstracted the records of 497 patients with severe AS who underwent TAVR between January 2016 and July 2019 at our institution. All patients underwent a non-contrast cardiac CT scan on a Siemens Somatom Definition Flash 128 slice scanner. AVC score using the Agatston method was calculated retrospectively. Primary outcome was 1-year mortality. Patients were divided into two groups: 1) Non-severe AVC score group [women &amp;lt;1200 Agatston unit (AU) and men &amp;lt;2000 AU]; 2) Severe AVC Score group [women &amp;gt;1200 AU and men &amp;gt;2000 AU]. Cox-regression model was used to predict effect of variables on 1-year mortality in male and female patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Among 466 patients included, 268 patients were male and 198 were female (57.5% vs 42.5%). When compared with males, female patients had significantly lower AVC score (p&amp;lt;0.001), aortic valve area (AVA) (p&amp;lt;0.001), obstructive CAD (p&amp;lt;0.001), and history of previous PCI (p&amp;lt;0.004), and CABG (&amp;lt;0.001) but had a significantly higher STS score (6.7±3.2 vs 5.8±3.3 P=0.01). There was no difference between need for permanent pacemaker (PPM) implantation (11% vs 9.6%, p=0.4), major complications (16% vs 15%, p=0.9), stroke (0.8% vs 1.6%, p=0.7), 30-day (3.7% vs 4%, p=0.9), and 1-year mortality (14% vs 12%, p=0.6) between males and females, respectively. Female patients required smaller bio-prosthetic valves compared with males (26±3.2 vs 30±3, p&amp;lt;0.001). Cox regression analysis for female patients showed BMI, hemoglobin level, and AVA independently predicted 1-year mortality, while there was no impact of severe AVC score (&amp;gt;1200 AU) on 1-year mortality in females. Similarly, Cox regression analysis for male patients showed there was no impact of severe AVC score (&amp;gt;2000 AU) on 1-year mortality in males. When males in the severe AVC group were compared with female patients in the severe AVC group, there was no difference in 30 day (4.3% vs 3.3%, p=0.82) and 1-year mortality (14.2% vs 13.3%, p=0.77). Similarly, in the severe AVC group there was no difference between need for PPM implantation (12.8% vs 12.1%, p=0.9), major complications (19.7% vs 15.8%, p=0.4), and stroke (2.2% vs 1%, p=0.6) between males and females, respectively.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>There were no sex differences in the impact of AVC score on mortality and post-procedural outcomes after TAVR.</jats:p> </jats:sec> <jats:sec> <jats:title>Funding Acknowledgement</jats:title> <jats:p>Type of funding sources: None.</jats:p> </jats:sec>