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INTRODUCTION: Sex disparities exist in coronary artery disease (CAD) in terms of risk profile, clinical management and outcome. It is unclear if differences are also present in coronary aneurysms, a rare variant of CAD. METHODS: Patients were selected from the international Coronary Artery Aneurysm Registry (CAAR; ClinicalTrials.gov: NCT02563626), and differences between groups were analysed according to sex. The CAAR database is a prospective multicentre registry of 1565 patients with coronary aneurysms (336 females). Kaplan-Meier method was used for event-free survival analysis for death, major adverse cardiac events (MACE: composite endpoint of death, heart failure and acute coronary syndrome) and bleeding. RESULTS: Female patients were older, were more often hypertensive and less frequently smoker. They were treated conservatively more often compared to male patients and received significantly less frequently aspirin (92% vs 88%, pâ¯= 0.002) or dual antiplatelet therapy (DAPT) (67% vs 58%, pâ¯= 0.001) at discharge. Median DAPT duration was also shorter (3 vs 9 months, pâ¯= 0.001). Kaplan-Meier analysis revealed no sex differences in death, MACE or bleeding during a median follow-up duration of 37 months, although male patients did experience acute coronary syndrome (ACS) more often during follow-up (15% vs 10%, pâ¯= 0.015). CONCLUSIONS: These CAAR findings showed a comparable high-risk cardiovascular risk profile for both sexes. Female patients were treated conservatively more often and received DAPT less often at discharge, with a shorter DAPT duration. ACS was more prevalent among male patients; however, overall clinical outcome was not different between male and female patients during follow-up.
Assuntos
Valvuloplastia com Balão/métodos , Causas de Morte , Estenose da Valva Mitral/mortalidade , Estenose da Valva Mitral/terapia , Fatores Etários , Idoso , Valvuloplastia com Balão/mortalidade , Estudos de Coortes , Intervalo Livre de Doença , Ecocardiografia Doppler/métodos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Estenose da Valva Mitral/diagnóstico por imagem , Recidiva , Retratamento/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND:Cardiac biomarker release signifying myocardial injury post-transcatheter aortic valve replacement (TAVR) is common, yet its clinical impact within a large TAVR cohort receiving differing types of valve and procedural approaches is unknown.OBJECTIVES:This study sought to determine the incidence, clinical impact, and factors associated with cardiac biomarker elevation post TAVR.METHODS:This multicenter study included 1,131 consecutive patients undergoing TAVR with balloon-expandable (58%) or self-expandable (42%) valves. Transfemoral and transapical (TA) approaches were selected in 73.1% and 20.3% of patients, respectively. Creatine kinase-myocardial band (CK-MB) measurements were obtained at baseline and at several time points within the initial 72 h post TAVR. Echocardiography was performed at baseline and at 6- to 12-month follow-up.RESULTS:Overall, 66% of the TAVR population demonstrated some degree of myocardial injury as determined by a rise in CK-MB levels (peak value: 1.6-fold [interquartile range (IQR): 0.9 to 2.8-fold]). A TA approach and major procedural complications were independently associated with higher peak of CK-MB levels (p < 0.01 for all), which translated into impaired systolic left ventricular function at 6 to 12 months post TAVR (p < 0.01). A greater rise in CK-MB levels independently associated with an increased 30-day, late (median of 21 [IQR: 8 to 36] months) overall and cardiovascular mortality (p < 0.001 for all)...
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Biomarcadores , Creatina Quinase , Estenose das Carótidas , Substituição da Valva Aórtica TranscateterRESUMO
Paravalvular aortic regurgitation (AR) is a frequent complication following transcatheter aortic valve implantation (TAVI) with an incidence of mild to moderate AR almost systematically higher than 30%. Moreover, several studies have shown that AR has a negative impact on short and mid-term mortality. Balloon postdilation has been proposed as an initial periprocedural option for patients with paravalvular AR to obtain a better expansion of the stent valve frame and potentially reduce the severity of the leak. The aim of this review is to discuss the current available literature on balloon postdilation as a treatment of paravalvular AR after TAVI, its impact on clinical events and future perspectives.