Impact of gender on outcome in aortic stenosis

Objective Some studies have shown sex differences in the pathophysiology of aortic stenosis (AS). However, sex-related outcome in AS remain unclear. We sought to investigate the prognostic impact of gender in a large cohort of AS. Methods A total of 2,348 patients with AS defined by aortic valve area (AVA)  2 were included. The primary endpoint was long term overall mortality and the secondary endpoint, long-term cardiovascular mortality. Results A total of 1211 patients were men and 1137 women. At baseline, women were older ( P P P P  = 0.156) even after further adjustment for surgery (adjusted HR: 0.865 [0.745–1.003]; P  = 0.055). For cardiovascular mortality, five-year survival was 88.5 ± 1% for men and 85% ± 2% for women ( P  = 0.001). On multivariate analysis, there was no difference between genders (adjusted HR: 0.996 [0.760–1.304]; P  = 0.976), even after further adjustment for surgery (adjusted HR: 1.000 [0.788–1.267]; P  = 0.997). The results were similar in the subgroup of severe AS ( n  = 1608, 68%), except a slight increase in overall mortality for men after adjustment for surgery (adjusted HR: 0.782 [0.630–0.971]; P  = 0.026) ( Fig. 1 ). Conclusion The current study shows that female gender was a predictor of all cause and cardiovascular mortality in univariate analysis, but this over-risk disappears in the multivariate analysis for both, overall and severe AS population. Women were significantly older and more symptomatic than men, due to more severe AS at baseline, suggesting a delay in their AS management which need to be considered.