Impact of Coronary Artery Disease on Cardiovascular Outcomes Differs Between Men and Women With Severe Aortic Stenosis

Brown, K; Xu, K; Hahn, RT; Pibarot, P; Leipsic, JA; Ma, Y; Clavel, MA; Elmariah, S; Weissman, NJ; Asch, FM; Khalique, OK; Leon, MB; Cremer, PC; Lindman, BR; Alu, MC; Douglas, PS; Daubert, MA

doi:10.1161/circinterventions.124.014999

Impact of Coronary Artery Disease on Cardiovascular Outcomes Differs Between Men and Women With Severe Aortic Stenosis

Circ Cardiovasc IntervPublished 27 May 2025Multivariable Cox proportional-hazards analysis of patients in the PARTNER 1, 2, and 3 trials and registries

Main finding · Death, heart failure hospitalization, or strokeResultAdjusted hazard ratio 0.92 CI 0.84–1.00

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Authors' conclusion

Obstructive CAD was associated with a higher risk of long-term adverse events after treatment for severe AS, but there was a significant sex disparity in clinical outcomes among men and women with no obstructive CAD. Further study is needed to optimize the evaluation and management of women with severe AS.

Study context

Population: Patients with severe aortic stenosis (AS) in the PARTNER 1, 2, and 3 trials and registriespatients with severe AS
Participants: 7,505 patients

Exposure: No obstructive coronary artery disease (CAD) compared with those with obstructive CAD
No obstructive CADn = 2,062
Outcome: Death, heart failure hospitalization, or stroke
Follow-up: 5 years

Main finding

As reported in the abstract

Adjusted hazard ratio

0.92

CI 0.84–1.00

P = 0.04

No obstructive CADvs obstructive CAD

adjusted hazard ratio 0.92 (CI 0.84–1.00); P = 0.04

Observational data: associations, not effects.

Further findings

Outcome	← Lower ←→ Higher →	Adjusted hazard ratio (CI)	P value
Primary end point in menMen with no obstructive CADvs men with obstructive CAD16% lower event rate	0.512	0.84 (0.73–0.96)	P = 0.01
Primary end point in womenWomen with no obstructive CADvs women with obstructive CAD	0.512	0.95 (0.85–1.07)	P = 0.41
	0.512Adjusted hazard ratio (log scale)

Women vs men with no obstructive CAD

Women with no obstructive CAD had a more advanced heart failure phenotype and higher event rates compared with men with no obstructive CAD

Characteristics of patients with no obstructive CAD

No obstructive CAD: 2062 (27.5%)
Women: 60.5%

Fewer CAD risk factors

Original publication

Impact of Coronary Artery Disease on Cardiovascular Outcomes Differs Between Men and Women With Severe Aortic Stenosis. Circ Cardiovasc Interv. Published 27 May 2025. doi:10.1161/circinterventions.124.014999

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