11 The influence of ethnicity on clinical outcomes following transcatheter aortic valve implantation (TAVI)

Background We have previously shown that minority ethnic groups are proportionately represented in the cohort of patients undergoing TAVI at our centre. This was an encouraging finding, however, the relationship between ethnicity and clinical outcomes following TAVI in our local population is unknown. Concerningly, this finding is reflected in a wider lack of published work on this important topic. Aim To analyse the influence of ethnicity on outcomes following TAVI in a continuous cohort of patients treated at a tertiary referral centre in the UK over the last 10 years. Methods A retrospective analysis of 1049 patients (9.7% non-white) undergoing TAVI from 2013 to 2023 was conducted. Data was submitted to National Institute for Cardiovascular Outcomes Research (NICOR) TAVI database. Primary outcomes included death and composite 3-point major adverse cardiac events (MACE) (death, from any cause, non-fatal myocardial infarction, and stroke) before discharge during TAVI admission. Post-TAVI survival time was also assessed. Given the relatively low number of events, a composite group of non-white patients was created. Variables were compared using Chi-squared or student's t-test. Cox regression analysis was performed for independent predictors of survival. Procedural outcomes were adjusted using multivariate regression. Results In our cohort of 1049 TAVI patients, 90.3% were white, 2.4% black, 5.5% Asian, 0.2% Chinese and 1.5% other/unknown. At baseline, non-white patients in our cohort were 3 years younger, (83.0 ± 7.0 vs 80.0 ± 7.8, p < 0.01) but more likely to have diabetes (25.4% vs 48%, p < 0.01), New York Heart Association (NYHA) class IV Heart Failure (30.4% vs 41.2%, p = 0.03) and experience Canadian Cardiovascular Society (CCS) class IV angina (1.2% vs 4.9%, p = 0.01). Non-white patients were more likely to undergo non-elective TAVI (15.0% vs 27.5%, p < 0.01) and received smaller valves (28.22 mm ±2.855 vs 26.61 mm ±2.754, p <.001). Rates of death (2.5% vs 2.0%, p = 1) and 3-point MACE from TAVI to discharge (5.0% vs 6.9%, p = 0.4) did not differ significantly between groups. Post TAVI median survival between did not significantly differ (1538 days vs 1626 days, p = 0.8). Cox-regression showed ethnicity is not an independent predictor of survival (p=0.256) Categorical data presented as (white % vs non-white %). Continuous as (white ± standard deviation vs non-white ± standard deviation). Odds ratios adjusted. Conclusion Short term outcomes and median survival following TAVI do not significantly differ between white and non-white patients in our centre. However, non-white patients were found to have worse symptoms of heart failure and angina at baseline. Non-white patients were also more likely to undergo non-elective TAVI. This raises the possibility of delayed recognition or referral of aortic stenosis in non-white patients. Further, dedicated work is warranted to explore the reproducibility of this finding in larger, multi-centre cohorts. Conflict of Interest Nil