Sex Differences in Stroke Frequency and Severity Following Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiovascular Medicine
• Neurology
• Interventional Cardiology

Background:

• Stroke is a known complication following transcatheter aortic valve replacement (TAVR).
• Existing data on sex differences in post-TAVR stroke and stroke severity are limited.
• Disabling strokes significantly impact patient quality of life and outcomes.

Purpose of the Study:

• To investigate sex differences in the incidence and severity of stroke after TAVR.
• To identify potential disparities in stroke risk between men and women undergoing TAVR.

Main Methods:

• Retrospective cohort study using the National Inpatient Sample (2016-2021).
• Ascertainment of stroke and stroke severity via validated claims-based algorithms.
• Definition of disabling strokes as those leading to death or non-home discharge.
• Multivariable logistic regression analysis adjusting for covariates and cerebral embolic protection use.

Main Results:

• Women had a higher incidence of overall in-hospital stroke compared to men (2.31% vs. 1.69%).
• The increased stroke rate in women was primarily driven by a higher incidence of disabling strokes (1.61% vs. 1.01%).
• No significant sex difference was observed in the incidence of nondisabling strokes.

Conclusions:

• Women undergoing TAVR in contemporary practice face a higher risk of both overall and disabling strokes compared to men.
• Findings underscore the necessity for developing tailored strategies to mitigate stroke risk in female TAVR patients.
• Addressing sex-specific vulnerabilities is crucial for improving outcomes after TAVR.