Women and Black patients face higher risks and unequal access in advanced cardiovascular procedures

WOMEN AND BLACK PATIENTS FACE HIGHER RISKS AND UNEQUAL ACCESS IN ADVANCED CARDIOVASCULAR PROCEDURES

Women Experience Higher Risk of Serious Cardiovascular Events After Transcatheter Aortic Valve Implantation and Left Atrial Appendage Occlusion Device Placement

Black Patients with Chronic Limb-Threatening Ischemia Almost 50% More Likely to Require Major Amputation Yet 10% Less Likely to See a Vascular Specialist

 

Washington, D.C. – May 1, 2025 – New data finds women 8% more likely to experience major complications after transcatheter aortic valve implantation (TAVI) and 50% more likely after left atrial appendage occlusion (LAAO) device placement. Meanwhile, Black patients with chronic limb-threatening ischemia (CLTI) face a significantly higher combined rate of major amputation and death and are 10% more likely to require emergency care due to their condition. The data were presented today at the Society for Cardiovascular Angiography & Interventions (SCAI) 2025 Scientific Sessions.

Despite significant advances in cardiovascular care, Black patients and women continue to experience persistent differences in diagnosis, treatment, and health outcomes. Black individuals are disproportionately impacted by conditions such as heart failure and CLTI, often facing delayed diagnoses and limited access to specialized care. Women are more likely to be underdiagnosed due to atypical symptom presentation and remain underrepresented in clinical trials, resulting in treatment strategies that may not fully reflect their specific needs. For both groups, these differences are further exacerbated by socioeconomic inequities, creating barriers to timely, effective, and personalized care.

“After many decades, we are finally starting to see an increasing interest in addressing serious health outcomes among specific population groups,” said SCAI President James B. Hermiller, MD, MSCAI. “These presentations at the SCAI 2025 Scientific Sessions emphasize the urgent need for inclusive research and targeted interventions to broaden perspectives and participation in cardiovascular care.”

 

Despite Higher Incidence of Prosthesis Patient Mismatch, Women Do Not Experience Lower Long-Term Survival After Transcatheter Aortic Valve Implantation

TAVI is a minimally invasive procedure to replace a diseased aortic valve, most commonly done in patients with severe aortic stenosis (AS). As the prevalence of AS increases, the success rate of TAVI and proper valve selection are critical to ensure patient survival. One key challenge is prosthesis-patient mismatch (PPM) – when the implanted valve is too small for the patient’s body size, resulting in poor blood flow. This mismatch disproportionately affects women, due to anatomical differences such as smaller aortic annulus size. While self-expanding valves (SEVs) are generally associated with better hemodynamic performance compared to balloon-expandable valves (BEVs), the long-term impact of PPM severity – particularly in women – remains unclear.

To address this gap, researchers conducted a retrospective cohort study of 3,016 patients (1,338 women) who underwent native valve TAVI from 2012 to 2021, making it the largest registry to date focused on sex-based outcomes of PPM following TAVI. The primary outcome was all-cause mortality at five years, with secondary outcomes including PPM incidence, severity, and residual transvalvular gradients (or ease of blood flow). 

Despite a higher incidence and severity of prosthesis patient mismatch, women did not experience a decreased long-term survival after TAVI compared to men. Women had significantly higher rates of predicted PPM (26.2% vs. 18.2%) and similar measured PPM (26.7% vs. 24.1%) compared to men. But similar or improved long-term survival compared to men across all levels of PPM severity. Yet across all levels of PPM severity, women showed comparable or better five-year survival outcomes. Notably, neither moderate nor severe predicted PPM or measured PPM negatively impacted long-term survival in women.

SEVs were linked to markedly lower rates of predicted PPM (12.8% vs. 31.8%) and measured PPM (16.1% vs. 31.1%), and larger orifice areas, known to be the case with SEVs. Additionally, there were no significant risk-adjusted survival differences between valve types, emphasizing the importance of individualized prosthesis selection and lifetime valve management considerations. 

“These findings highlight the importance of selecting the right valve based on a comprehensive, long-term treatment strategy — not just immediate echocardiographic metrics that may have little influence on long-term outcomes,” said Karim Al-Azizi, MD, FACC, FSCAI, FESC, Baylor Scott & White Health - The Heart Hospital in Plano, Texas and lead author of the study. “This is a timely study, as the SMART data was recently released, and there was no clinical difference between valve types nor an increased risk of needing valve re-interventions. This also underscores the critical need to evaluate TAVI outcomes specifically in women, where assumptions about risk and benefit may not hold true, and overlooking those differences could lead to poor long-term outcomes.”

This abstract is published in SCAI’s official journal, JSCAI, here with an additional feature article here. 

 

Black Patients 46% More Likely to Undergo Major Amputation After Chronic Limb-Threatening Ischemia 

CLTI is a severe stage of peripheral artery disease (PAD) that leads to blocked blood flow in the arms and legs, often resulting in amputation or death if not properly treated. Almost 20% of patients with CLTI are Black, and Black patients have a 46% higher chance of amputation after CLTI. While efforts to raise awareness of unequal outcomes in PAD have increased, few studies have examined how care and results differ across socioeconomic groups. To help fill that gap, this study analyzed access to care and clinical outcomes among Black and white patients using data from a large, contemporary population of Medicare beneficiaries.

The analysis included 381,355 individuals who underwent endovascular revascularization for CLTI between 2016 and 2023. The primary outcome was a composite of major amputation and death within one year.

After one year, 31.5% of Black patients experienced the primary outcome of major amputation and death, compared to 27.6% of white patients. This difference was driven by a 45.6% higher risk of major amputation for Black patients. Paradoxically, Black patients had a 10% lower risk of mortality compared to white patients. Black patients were 10% less likely to see a vascular specialist before revascularization and 8% less likely after revascularization, but were 10% more likely to have CLTI-related emergency visits and 26% more likely for admissions compared to white patients. 

“Black patients make up nearly 20% of the CLTI population but face nearly a 50% higher risk of amputation compared to white patients,” said Joseph M. Kim, MD, Beth Israel Deaconess Medical Center in Boston and lead author of the study. “These findings highlight the ongoing challenges Black patients face in accessing timely vascular care. While they’re less likely to see a specialist, they’re more likely to need emergency care, underscoring the urgent need for improved care pathways that reach all patients effectively.”

Further research is needed to determine the most effective strategies for early PAD detection and to assess how system-level changes can improve outcomes equitably.

This abstract is published in the SCAI Abstract Supplement, which appears in SCAI’s official journal, JSCAI. You can access it here: https://doi.org/10.1016/j.jscai.2025.102657. 

 

Women Twice as Likely to Die Than Men After Left Atrial Appendage Occlusion Device Placement

For some patients with atrial fibrillation (AFib), LAAO devices are often used to prevent clot formation and embolization, offering an alternative to lifelong blood thinners. These devices are particularly beneficial for stroke prevention in patients who cannot tolerate blood-thinning medications. Despite growing attention to sex-based differences in healthcare outcomes, there is a lack of large-scale studies exploring how sex influences the success and complications of this procedure. 

Researchers looked at data from the National Inpatient Sample (NIS) database from 2016 to 2020 sample that included 81,474 adult patients with a diagnosis of AFib who underwent percutaneous LAAO device placement. The primary outcome was in-hospital mortality, with secondary outcomes including length of stay, total hospitalization costs, and procedural complications.

The study found that 140 patients (1.7%) experienced the primary outcome of mortality. However, the results highlighted a striking difference: women were more than twice as likely to die compared to men. In addition, women faced 50% higher odds of vascular complications and a 22% higher likelihood of stroke than their male counterparts, even after adjusting for factors like age, race, and other health conditions. Beyond these risks, women also had slightly longer hospital stays (an average of 0.22 days more) and $2,994 higher hospital charges.

“Although the overall rate of complication was low, our analysis makes it clear that women are still in danger as they are at higher risk of mortality and complications following percutaneous left atrial appendage occlusion device placement,” said Jeremiah Bello, MD, John H. Stroger, Jr. Hospital of Cook County in Chicago, Ill. and lead author of the study. “This could be related to anatomical differences or the fact that women often have a higher baseline risk for stroke. There's definitely more to explore here, particularly around whether women could benefit from more aggressive blood-thinning treatments after the procedure.” 

Further studies are needed to confirm these findings.

This abstract is published in the SCAI Abstract Supplement, which appears in SCAI’s official journal, JSCAI. You can access it here: https://doi.org/10.1016/j.jscai.2025.103019.  

 

Session Details:

“Incidence and Gender-Based Comparison of Prosthesis-Patient Mismatch (PPM) in patients undergoing transcatheter aortic valve implantation (TAVI)”

Thursday, May 1, 2025; 10:57-11:05 AM ET

Walter E. Washington Convention Center, SCAI Central, Hall D

“Persistent Racial Disparities in Access to Care and Outcomes Following Revascularization for Chronic Limb-Threatening Ischemia Between Black and White Medicare Beneficiaries”

Thursday, May 1, 2025; 11:35-11:43 AM ET

Walter E. Washington Convention Center, Hall D, Theater 1

“Gender based disparities in in-hospital Outcomes of Percutaneous Left Atrial Appendage Occlusion Device Insertion”

Friday, May 2, 2025; 10:50-12:15 PM ET

Walter E. Washington Convention Center, Hall D, Theater 1

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About Society for Cardiovascular Angiography & Interventions (SCAI)

The Society for Cardiovascular Angiography & Interventions, established in 1978, stands as the primary nonprofit medical society dedicated to representing invasive and interventional cardiology. SCAI's mission is to guide the global interventional cardiovascular community by fostering education, advocacy, research, and upholding standards for quality patient care. For more than 40 years, SCAI has exemplified professional excellence and innovation worldwide, cultivating a reputable community of over 5,000 members committed to advancing medical science and providing life-saving care for individuals, both adults and children, affected by cardiovascular disease. For more information, visit https://scai.org/. 

For more information about the SCAI 2025 Scientific Sessions, visit https://scai.org/scai-2025-scientific-sessions. Follow @SCAI on X for the latest heart health news and use #SCAI2025 to follow the latest discussions.

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