Sex-specific predictors of mortality following balloon aortic valvuloplasty

Abstract Background A differential impact of sex has been observed in balloon aortic valvuloplasty (BAV) outcomes from small observational studies. Accordingly, we sought to compare mortality in men and women undergoing BAV and identify sex-specific predictors of mortality. Methods The Nationwide Inpatient Sample was screened for hospitalizations involving adults who underwent BAV between 2006 and 2014. Demographic data and clinical history were recorded. In-hospital mortality and predictors of death after BAV were assessed in men and women. Results Among an estimated national cohort of 18,415 adults undergoing BAV, 8871 (48.2%) were women and 9543 (51.8%) were men. Compared with male patients, women were older, with a lower prevalence of coronary artery disease, prior myocardial infarction, diabetes mellitus, chronic kidney disease, chronic obstructive lung disease, and peripheral arterial disease but a higher rate of hypertension and obesity. In-hospital mortality rates were 6.7% and 9.4% in women and men respectively (p = 0.004). In multivariable regression analysis, female sex was independently associated with lower mortality [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.57–0.93) following BAV. Sex-specific risk-adjusted predictors of mortality included atrial fibrillation in women and younger age, congestive heart failure, chronic kidney disease, and absence of prior myocardial infarction, hypertension, and peripheral arterial disease in men. Conclusions Women undergoing BAV had a different risk profile compared to men. Risk-adjusted in-hospital mortality was lower in women, and disparate predictors of risk-adjusted mortality exist in men and women undergoing BAV. Further studies are warranted to determine whether preventive interventions can improve outcomes in both men and women in this high-risk population.