Some studies have shown sex differences in the pathophysiology of aortic stenosis (AS). However, sex-related outcome in AS remain unclear. We sought to investigate the prognostic impact of gender in a large cohort of AS.

A total of 2,348 patients with AS defined by aortic valve area (AVA)<2cm² were included. The primary endpoint was long term overall mortality and the secondary endpoint, long-term cardiovascular mortality.

A total of 1211 patients were men and 1137 women. At baseline, women were older (P<0.001) and more symptomatic (P<0.001) than men. Overall five-year survival was 70±4% for men and 65±3% for women (P<0.001). However, on multivariate analysis, after adjustment for covariate of prognosis importance including age and symptoms, both sex found to have a similar long-term prognosis (adjusted HR: 0.882 [0.741–1.049]; P=0.156) even after further adjustment for surgery (adjusted HR: 0.865 [0.745–1.003]; P=0.055). For cardiovascular mortality, five-year survival was 88.5±1% for men and 85%±2% for women (P=0.001). On multivariate analysis, there was no difference between genders (adjusted HR: 0.996 [0.760–1.304]; P=0.976), even after further adjustment for surgery (adjusted HR: 1.000 [0.788–1.267]; P=0.997). The results were similar in the subgroup of severe AS (n=1608, 68%), except a slight increase in overall mortality for men after adjustment for surgery (adjusted HR: 0.782 [0.630–0.971]; P=0.026) (Figure 1).

The current study shows that female gender was a predictor of all cause and cardiovascular mortality in univariate analysis, but this over-risk disappears in the multivariate analysis for both, overall and severe AS population. Women were significantly older and more symptomatic than men, due to more severe AS at baseline, suggesting a delay in their AS management which need to be considered.