In-hospital bleeding, 30-day mortality higher among women undergoing TAVI

Women undergoing transcatheter aortic valve implantation (TAVI) experience higher rates of periprocedural major bleeding events and 30-day mortality, according to new findings published in the American Journal of Cardiology. Long-term mortality was similar between the two sexes.

The study tracked nearly 700 patients who underwent TAVI at one of two facilities in Melbourne, Australia, from August 2008 to July 2018. Forty-eight percent of those patients were women, and the mean patient age was 83.2 years old. Women included in the study were, on average, approximately one year older than the men.

Overall, women had higher mean Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score (5.2) than men (4.6), but comorbidities were more common among men. Women also had higher rates of in-hospital bleeding events (3.3% compared to 1%) and 30-day mortality (2.4% compared to 0.3%) than men.

“Women in our cohort had higher rates of peri-procedural major bleeding,” wrote lead author Julia Stehli, MD, department of cardiology at Alfred Hospital in Melbourne, Australia, and colleagues. “Previous reports have demonstrated conflicting results, with some studies demonstrating similar rates of bleeding between men and women and other reports in agreement with ours. In our cohort, bleeding was due to access site vascular complications in 46% in women and in 50% in men. This is interesting, given the fact that the higher bleeding rates in women were often interpreted as a consequence of smaller femoral artery sizes in women, leading to more vascular complications.”

One-year mortality, the team added, was “similar” among the two groups: 8.3% for women and 7.8% for men. In addition, a higher percentage of men needed a permanent pacemaker (24.2% compared to 19.5%) than women.

Stehli et al. concluded by looking at the importance of these findings moving forward.

“As valvular technology improves and patient cohorts become more diverse, the role of sex on outcomes will continue to be dynamic,” they wrote. “Reduction of peri-procedural complications, including major bleeding for women, should be a focus of future developments.”