Medtronic, Inc. (NYSE: MDT) today announced new results from the
Medtronic CoreValve ADVANCE Study, which found that women and men
benefitted similarly from the Medtronic CoreValve® System. The study,
presented at EuroPCR 2012, evaluated patients who were at high-risk for
surgical aortic valve replacement. The Medtronic CoreValve System is
currently limited to investigational use in the United States.
The gender analysis, a secondary-endpoint evaluation in the real-world
CoreValve ADVANCE Study, found that survival rates were nearly identical
between genders, with no statistical differences in 30-day and 6-month
all-cause mortality, cardiovascular mortality or the 30-day MACCE
endpoint (Major Adverse Cardiac & Cerebrovascular Events, a composite of
all-cause mortality, myocardial infarction, emergent cardiac surgery or
percutaneous re-intervention, and stroke).
Overall, patients experienced low 30-day stroke rates (2.9 percent
overall), with the combined stroke rates of major and minor strokes
being very low (major 1.2 percent, and minor 1.7 percent). However,
female patients experienced a statistically higher rate of strokes (4.4
percent vs. 1.4 percent; p-value <0.01), major vascular complications
(14.1 percent vs. 7.1 percent; p-value <0.01) and major bleeding (5.0
percent vs. 3.1 percent; p-value <0.01). For minor stroke between
genders, and for major strokes between genders, differences were not
significant, though there was a trend for women to have more minor
strokes than men.
"This study is an important contribution to the growing base of research
on TAVI, and sheds light on the unique needs for managing severe aortic
stenosis in women," said Patrizia Presbitero, M.D., director of
Interventional Cardiology at Hospital Humanitas Rozzano in Milan and an
investigator in the CoreValve ADVANCE Study, and a professional
development co-chair and member of the Leadership Council of WIN (Women
in Innovations/Society for Cardiovascular Angiography and Interventions,
SCAI). "We need to know more about gender differences to effectively
treat patients with heart disease in a more specific way, taking into
account those differences that can affect treatment."
Women and men benefited similarly from the CoreValve System even though
women (51 percent of patients) and men (49 percent of patients) had
different risk profiles. Specifically, at the time of enrollment, women
as compared to men were:
-
Older than males (82.2 years vs. 79.9 years; p-value <0.001);
-
Had higher average gradients (47.6 vs. 43.5 mmHg; p-value <0.001) and
peak gradients (79.0 vs. 72.5 mmHg; p-value <0.001), a measure of
blood flow across the valve;
-
Had less coronary artery disease (46 percent vs. 70 percent; p-value
<0.001); and
-
Were prescribed fewer cardiovascular medications, including
cholesterol-lowering medications (p-value 0.002) and statins (p-value
0.013).
"The robust ADVANCE trial provides a compelling discovery that the
CoreValve System is an excellent therapeutic option for both men and
women, and it helps us begin to consider how men and women present
differently prior to implant and might be managed accordingly," said
Axel Linke, M.D., professor of medicine at Universitat Leipzig
Herzzentrum in Leipzig, Germany and principal investigator of the
ADVANCE clinical trial. "An important next step will be to further
evaluate why stroke events were more common for women, including the
possible role of medications which were prescribed less frequently for
women in this study."