Female-specific survival advantage from transcatheter aortic valve implantation over surgical aortic valve replacement: Meta-analysis of the gender subgroups of randomised controlled trials including 3758 patients

Vasileios F Panoulas, Darrel P Francis, Neil Ruparelia, Iqbal S Malik, Andrew Chukwuemeka, Sayan Sen, Jonathan Anderson, Petros Nihoyannopoulos, Nilesh Sutaria, Edward L Hannan, Zaza Samadashvili, Paola D'Errigo, Gerhard Schymik, Roxana Mehran, Alaide Chieffo, Azeem Latib, Patrizia Presbitero, Julinda Mehilli, Anna Sonia Petronio, Marie-Claude MoriceCorrado Tamburino, Hans G H Thyregod, Martin Leon, Antonio Colombo, Ghada W Mikhail

Research output: Contribution to journalArticle

Abstract

Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is the first area of interventional cardiology where women are treated as often as men. In this analysis of the gender specific results of randomised controlled trials (RCTs) comparing TAVI with surgical aortic valve replacement (SAVR) we aimed to determine whether gender affects the survival comparison between TAVI and SAVR. We identified all RCTs comparing TAVI versus SAVR for severe AS and reporting 1 and/or 2year survival. Summary odds ratios (ORs) were obtained using a random-effects model. Heterogeneity was assessed using the Q statistic and I2. Four RCTs met the criteria, totalling 3758 patients, 1706 women and 2052 men. Amongst females, TAVI recipients had a significantly lower mortality than SAVR recipients, at 1year (OR 0.68; 95%CI 0.50 to 0.94) and at 2years (OR 0.74; 95%CI 0.58 to 0.95). Amongst males there was no difference in mortality between TAVI and SAVR, at 1year (OR 1.09; 95%CI 0.86 to 1.39) or 2years (OR 1.05; 95%CI 0.85 to 1.3). The difference in treatment effect between genders was significant at both 1year (pinteraction=0.02) and 2years (pinteraction=0.04). In women TAVI has a 26 to 31% lower mortality odds than SAVR. In men, there is no difference in mortality between TAVI and SAVR.

Original languageEnglish
Pages (from-to)66-72
Number of pages7
JournalInternational Journal of Cardiology
Volume250
DOIs
Publication statusPublished - Jan 1 2018

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Aortic Valve
Surgical Instruments
Meta-Analysis
Randomized Controlled Trials
Survival
Odds Ratio
Mortality
Aortic Valve Stenosis
Transcatheter Aortic Valve Replacement
Cardiology

Keywords

  • transcatheter aortic valve replacement
  • Female
  • surgical aortic valve replacement
  • Randomized Controlled
  • Meta-analvsis

Cite this

Female-specific survival advantage from transcatheter aortic valve implantation over surgical aortic valve replacement : Meta-analysis of the gender subgroups of randomised controlled trials including 3758 patients. / Panoulas, Vasileios F; Francis, Darrel P; Ruparelia, Neil; Malik, Iqbal S; Chukwuemeka, Andrew; Sen, Sayan; Anderson, Jonathan; Nihoyannopoulos, Petros; Sutaria, Nilesh; Hannan, Edward L; Samadashvili, Zaza; D'Errigo, Paola; Schymik, Gerhard; Mehran, Roxana; Chieffo, Alaide; Latib, Azeem; Presbitero, Patrizia; Mehilli, Julinda; Petronio, Anna Sonia; Morice, Marie-Claude; Tamburino, Corrado; Thyregod, Hans G H; Leon, Martin; Colombo, Antonio; Mikhail, Ghada W.

In: International Journal of Cardiology, Vol. 250, 01.01.2018, p. 66-72.

Research output: Contribution to journalArticle

Panoulas, VF, Francis, DP, Ruparelia, N, Malik, IS, Chukwuemeka, A, Sen, S, Anderson, J, Nihoyannopoulos, P, Sutaria, N, Hannan, EL, Samadashvili, Z, D'Errigo, P, Schymik, G, Mehran, R, Chieffo, A, Latib, A, Presbitero, P, Mehilli, J, Petronio, AS, Morice, M-C, Tamburino, C, Thyregod, HGH, Leon, M, Colombo, A & Mikhail, GW 2018, 'Female-specific survival advantage from transcatheter aortic valve implantation over surgical aortic valve replacement: Meta-analysis of the gender subgroups of randomised controlled trials including 3758 patients', International Journal of Cardiology, vol. 250, pp. 66-72. https://doi.org/10.1016/j.ijcard.2017.05.047
Panoulas, Vasileios F ; Francis, Darrel P ; Ruparelia, Neil ; Malik, Iqbal S ; Chukwuemeka, Andrew ; Sen, Sayan ; Anderson, Jonathan ; Nihoyannopoulos, Petros ; Sutaria, Nilesh ; Hannan, Edward L ; Samadashvili, Zaza ; D'Errigo, Paola ; Schymik, Gerhard ; Mehran, Roxana ; Chieffo, Alaide ; Latib, Azeem ; Presbitero, Patrizia ; Mehilli, Julinda ; Petronio, Anna Sonia ; Morice, Marie-Claude ; Tamburino, Corrado ; Thyregod, Hans G H ; Leon, Martin ; Colombo, Antonio ; Mikhail, Ghada W. / Female-specific survival advantage from transcatheter aortic valve implantation over surgical aortic valve replacement : Meta-analysis of the gender subgroups of randomised controlled trials including 3758 patients. In: International Journal of Cardiology. 2018 ; Vol. 250. pp. 66-72.
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T2 - Meta-analysis of the gender subgroups of randomised controlled trials including 3758 patients

AU - Panoulas, Vasileios F

AU - Francis, Darrel P

AU - Ruparelia, Neil

AU - Malik, Iqbal S

AU - Chukwuemeka, Andrew

AU - Sen, Sayan

AU - Anderson, Jonathan

AU - Nihoyannopoulos, Petros

AU - Sutaria, Nilesh

AU - Hannan, Edward L

AU - Samadashvili, Zaza

AU - D'Errigo, Paola

AU - Schymik, Gerhard

AU - Mehran, Roxana

AU - Chieffo, Alaide

AU - Latib, Azeem

AU - Presbitero, Patrizia

AU - Mehilli, Julinda

AU - Petronio, Anna Sonia

AU - Morice, Marie-Claude

AU - Tamburino, Corrado

AU - Thyregod, Hans G H

AU - Leon, Martin

AU - Colombo, Antonio

AU - Mikhail, Ghada W

N1 - Copyright © 2017 Elsevier B.V. All rights reserved.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is the first area of interventional cardiology where women are treated as often as men. In this analysis of the gender specific results of randomised controlled trials (RCTs) comparing TAVI with surgical aortic valve replacement (SAVR) we aimed to determine whether gender affects the survival comparison between TAVI and SAVR. We identified all RCTs comparing TAVI versus SAVR for severe AS and reporting 1 and/or 2year survival. Summary odds ratios (ORs) were obtained using a random-effects model. Heterogeneity was assessed using the Q statistic and I2. Four RCTs met the criteria, totalling 3758 patients, 1706 women and 2052 men. Amongst females, TAVI recipients had a significantly lower mortality than SAVR recipients, at 1year (OR 0.68; 95%CI 0.50 to 0.94) and at 2years (OR 0.74; 95%CI 0.58 to 0.95). Amongst males there was no difference in mortality between TAVI and SAVR, at 1year (OR 1.09; 95%CI 0.86 to 1.39) or 2years (OR 1.05; 95%CI 0.85 to 1.3). The difference in treatment effect between genders was significant at both 1year (pinteraction=0.02) and 2years (pinteraction=0.04). In women TAVI has a 26 to 31% lower mortality odds than SAVR. In men, there is no difference in mortality between TAVI and SAVR.

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