Nonagenarian status was independently associated with a 21% increased risk of 1-year all-cause mortality (HR 1.21) compared to patients aged <90 years undergoing transfemoral transcatheter aortic valve replacement.
Cohort (n=15,028)
Yes
Does transfemoral TAVR in nonagenarians result in worse clinical outcomes compared to patients aged <90 years?
In a Japanese nationwide registry, carefully selected nonagenarians undergoing TAVR had similar 30-day outcomes but a 21% to 24% increased risk of 1-year mortality and composite adverse events compared to younger patients.
Hazard Ratio: 1.21 (95% CI 1.03–1.42)
Absolute Event Rate: 10.3% vs 6.8%
p-value: p=0.023
Nonagenarians are a growing age group in patients undergoing transcatheter aortic valve replacement (TAVR); however, the appropriate use of TAVR in this population remains discussed because of their limited life expectancy and worse outcome reported. The authors aimed to evaluate clinical characteristics and the prognostic impact of nonagenarians. We analyzed consecutive patients undergoing transfemoral TAVR and were registered in the nationwide registry for TAVR in Japan (Japanese Transcatheter Valvular Therapies registry) between 2013 and 2018. The rate of 30-day and 1-year mortality and composite adverse event, comprising all-cause death, all stroke, and life-threatening/major bleeding, were assessed. Of the 15,028 registered patients during the study period, 2,215 (14.7%) were nonagenarians. Although the nonagenarians were less likely to have comorbid conditions (eg, diabetes mellitus and malignancy) than patients aged <90 y, they had a higher Society of Thoracic Surgeons risk score (8.8% vs 5.6%), mainly owing to their advanced age. The procedural characteristics were identical between 2 groups. The rate of 30-day mortality and composite endpoint was similar, whereas 1-year mortality and composite adverse events were increased among nonagenarians (10.3% vs 6.8% and 13.5% vs 9.2%, respectively), and nonagenarians were independently associated with these endpoints (HR: 1.21; 95% CI: 1.03-1.42; P = 0.023; HR: 1.24; 95% CI: 1.07-1.42; P = 0.004). Of the 15,028 TAVR procedures performed in Japan between 2013 and 2018, 14.7% were performed in nonagenarians. These patients were carefully selected by a multidisciplinary heart team and showed 21% and 24% increase of 1-year mortality and composite adverse outcome.
Higuchi et al. (Tue,) conducted a cohort in Severe aortic stenosis (n=15,028). Nonagenarian status (Age ≥90 years) vs. Patients aged <90 years was evaluated on 1-year all-cause mortality (HR 1.21, 95% CI 1.03-1.42, p=0.023). Nonagenarian status was independently associated with a 21% increased risk of 1-year all-cause mortality (HR 1.21) compared to patients aged <90 years undergoing transfemoral transcatheter aortic valve replacement.