Each 1-stage increase in baseline cardiac damage before aortic valve replacement was associated with a 24% increase in the odds of a poor 1-year outcome (OR 1.24; 95% CI 1.09-1.41; P=0.001).
Cohort (n=1,974)
Yes
Effect estimate: OR 1.24 (95% CI 1.09-1.41)
p-value: p=0.001
BACKGROUND: The extent of extravalvular cardiac damage is associated with increased risk of adverse events among patients with severe aortic stenosis undergoing aortic valve replacement (AVR). OBJECTIVES: The goal was to describe the association of cardiac damage on health status before and after AVR. METHODS: Patients from the PARTNER (Placement of Aortic Transcatheter Valves) 2 and 3 trials were pooled and classified by echocardiographic cardiac damage stage at baseline and 1 year as previously described (stage 0-4). We examined the association between baseline cardiac damage and 1-year health status (assessed by the Kansas City Cardiomyopathy Questionnaire Overall Score KCCQ-OS). RESULTS: Among 1,974 patients (794 surgical AVR, 1,180 transcatheter AVR), the extent of cardiac damage at baseline was associated with lower KCCQ scores both at baseline and at 1 year after AVR (P < 0.0001) and with increased rates of a poor outcome (death, KCCQ-OS <60, or a decrease in KCCQ-OS of ≥10 points) at 1 year (stages 0-4: 10.6% vs 19.6% vs 29.0% vs 44.7% vs 39.8%; P < 0.0001). In a multivariable model, each 1-stage increase in baseline cardiac damage was associated with a 24% increase in the odds of a poor outcome (95% CI: 9%-41%; P = 0.001). Change in stage of cardiac damage at 1 year after AVR was associated with the extent of improvement in KCCQ-OS over the same period (mean change in 1-year KCCQ-OS: improvement of ≥1 stage +26.8 95% CI: 24.2-29.4 vs no change +21.4 95% CI: 20.0-22.7 vs deterioration of ≥1 stage +17.5 95% CI: 15.4-19.5; P < 0.0001). CONCLUSIONS: The extent of cardiac damage before AVR has an important impact on health status outcomes, both cross-sectionally and after AVR. (PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - XT Intermediate and High Risk (PII A), NCT01314313; The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves - PII B PARTNERII B, NCT02184442; PARTNER 3 Trial: Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis P3, NCT02675114).
Généreux et al. (Wed,) conducted a cohort in Severe aortic stenosis (n=1,974). Baseline echocardiographic cardiac damage stage vs. Lower stages of cardiac damage was evaluated on Poor outcome at 1 year (death, KCCQ-OS <60, or a decrease in KCCQ-OS of ≥10 points) (OR 1.24, 95% CI 1.09-1.41, p=0.001). Each 1-stage increase in baseline cardiac damage before aortic valve replacement was associated with a 24% increase in the odds of a poor 1-year outcome (OR 1.24; 95% CI 1.09-1.41; P=0.001).