Stroke risk after TAVR still much higher for female patients

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Stroke risk after TAVR still much higher for female patients

Women are still associated with a significantly higher stroke risk after transcatheter aortic valve replacement (TAVR) than men, according to a new study published in the Journal of the American Heart Association.[1] Disabling strokes are the primary driver of this trend. 

“Sex differences have been documented for certain post‐TAVR outcomes, such as vascular complications and survival, but other outcomes remain less thoroughly explored,” wrote first author Vijay A. Joshi, BS, a researcher with the University of Colorado School of Medicine, and colleagues. “Stroke remains a feared complication of TAVR, though contemporary data on sex differences in post‐TAVR stroke are sparse.”

Joshi et al. explored in-hospital data from the National Inpatient Sample, focusing on nearly 380,000 TAVR patients treated from 2016 to 2021. Approximately 44% of patients were women, and their mean age was 79.3 years old. The mean age for men undergoing TAVR, meanwhile, was 78.2 years old.

Male patients were more likely to present with a history of smoking, coronary artery disease, myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft surgery, implantable cardioverter-defibrillator placement or chronic kidney disease. Female patients, on the other hand, were more likely to present with a history of obesity. 

The overall stroke rates were 2.31% for women and 1.69% for men. Disabling strokes—defined as any stroke that results in death or discharge to a facility other than home—were the primary cause for this difference between the two sexes. They occurred in 1.61% of women and 1.02% of men. 

“Our findings regarding differences in stroke and disabling stroke by sex have potentially important clinical implications,” the authors wrote. “Specifically, as clinicians counsel patients regarding treatment options for aortic stenosis, they should be aware that women may face a heightened risk of disabling stroke, which carries significant prognostic and quality‐of‐life implications. This underscores the potential value of investigating tailored procedural strategies, such as the use of embolic protection devices in women given their potential association with a reduction in disabling stroke in particular.”

The group also called for more research in the future examining what, exactly, causes this increased stroke risk when female patients undergo TAVR. Identifying the “anatomical, physiological and procedural factors” associated with this trend could lead to new prevention strategies and improved patient outcomes.

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